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Magdalena Hiler, Marek Czosnyka, Peter Hutchinson, Marcella Balestreri, Peter Smielewski, Basil Matta and John D. Pickard

according to the in-house algorithm, which is based on ICP and CPP monitoring. Volume expansion, dopamine, and/or norepinephrine were used to achieve a CPP of at least 70 mm Hg. Intracranial pressure higher than 20 mm Hg was treated actively. Data Acquisition Mean arterial blood pressure was obtained directly from the radial or dorsalis pedis artery using a standard monitoring kit (Baxter B.V., Utrecht, The Netherlands). Intracranial pressure was monitored continuously with an intraparenchymal transducer (Codman Microsensor ICP Transducer; Codman & Shurtlef, Inc

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Marek Czosnyka, Marcella Balestreri, Luzius Steiner, Piotr Smielewski, Peter J. Hutchinson, Basil Matta and John D. Pickard

and overall brain functionality seem to decrease. 4, 13, 14, 22 Although new magnetic resonance imaging—based studies in which a partial blood volume correction has been applied have posed a challenge to this belief. 15 Again, as in the case of cerebrovascular reactivity, results from acute traumatic brain injury are different from the studies in healthy volunteers. In this study we focused on continuous rather than threshold-like changes with age and collected our data in scatterplots ( Figs. 1 – 4 ), instead of performing other forms of analysis. From the

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Eric A. Schmidt, Marek Czosnyka, Luzius A. Steiner, Marcella Balestreri, Piotr Smielewski, Stefan K. Piechnik, Basil F. Matta and John D. Pickard

was treated with a bolus of mannitol (2 mg/kg), and the ABP was maintained by volume expansion and administration of dopamine and/or epinephrine at the discretion of the physician. The left and right middle cerebral arteries were insonated daily for a period ranging between 20 minutes and 2 hours by using a TCD ultrasonography system (Neuroguard [Medasonics, Fremont, CA], NeuroQ [Deltex, Chichester, UK], and Rimed IntraView [Rimed, Raanana, Israel]). The maximal left and right FVs were recorded. The median number of days recording took place was 3 days (range 1

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Christian Zweifel, Andrea Lavinio, Luzius A. Steiner, Danila Radolovich, Peter Smielewski, Ivan Timofeev, Magdalena Hiler, Marcella Balestreri, Peter J. Kirkpatrick, John D. Pickard, Peter Hutchinson and Marek Czosnyka

lead to vasoconstriction and a reduction of cerebral blood volume. Under the condition of a finite pressure-volume compensatory reserve, this reduction of cerebral blood volume will produce a decrease in ICP, a condition that is usually not met in patients after a decompressive craniectomy or in those with an external ventricular drain. When cerebrovascular pressure reactivity is impaired, cerebral blood volume—and therefore ICP—will increase or decrease passively (in the same direction) in response to changes in ABP. The assessment of cerebrovascular pressure