Pressure-volume index in head injury

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✓ The authors studied intracranial pressure (ICP) and intracranial compliance as defined by the pressure-volume index (PVI) in 34 severely head-injured patients with a Glasgow Coma Scale score of 8 or less. The objective of the research was to determine if there was a correlation between the pressure-volume status and subsequent increase in ICP. The PVI and ICP measurements were obtained serially, and the temporal course of the pressure-volume status and ICP was determined during the 5-day period following injury. Aggressiveness of ICP was quantified by a therapy intensity level scale. A clear relationship between the PVI measured soon after injury and subsequent development of ICP emerged. Following mechanical trauma the PVI is reduced, and the degree of reduction and extent of biomechanical recovery are closely related to outcome and development of raised ICP.

Article Information

Address for Dr. Maset: Hospital N.S. da Paz, S.J. do Rio Preto, São Paulo, Brazil.

Address for Dr. Moulton: Division of Neurosurgery, University of Toronto, Toronto, Alberta, Canada.

Address for Dr. DeSalles: Department of Neurosurgery, University Federal of Goias, Goias, Brazil.

Address reprint requests to: Anthony Marmarou, Ph.D., Division of Neurosurgery, P.O. Box 508, MCV Station, Richmond, Virginia 23298.

© AANS, except where prohibited by US copyright law.

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Figures

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    Comparison of pressure-volume index (PVI) from bolus addition and withdrawal. The PVI values on bolus withdrawal (PVIw) compare favorably with those on bolus injection: PVI(injection) = 2.65 ± 0.84 PVIw, r = 0.87, p < 0.005. This concordance allows the PVI to be determined safely in patients with elevated ICP and in whom bolus addition of fluid is not desirable.

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    The temporal course of intracranial pressure (ICP), pressure-volume index (PVI), and therapy intensity level (TIL) during the 5 days postinjury. Patients were subdivided on the basis of sustained ICP level (Group A: < 20 mm Hg; Group B: > 20 mm Hg, controllable; Group C: uncontrollable). Group A and B patients were associated with only a moderately reduced PVI and recovered toward a normal PVI level. Therapy in Groups A and B was also mild to moderate. Patients who developed a high ICP were associated with a low PVI and maximal TIL.

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    The temporal course of intracranial pressure (ICP), pressure-volume index (PVI), and therapy intensity level (TIL) in each outcome group. A: Group 1 patients with good or moderate outcome were associated with a mildly reduced PVI that gradually return toward normal. The ICP was only mildly elevated and TIL was minimal. B: Group 2 patients with poor outcome (severe disability or vegetative state: sev/veg) exhibited a moderately reduced PVI that did not tend toward normal over the 5-day course. The ICP was not significantly different from that of Group 1; however, more aggressive TIL was required to manage the ICP. C: Group 3 patients who died had the lowest PVI and maximal ICP despite maximal TIL.

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    Pressure-volume index (PVI) values measured within the first 24 hours after admission are distributed according to outcome groups. Average PVI levels of patients who died are significantly decreased compared to the survivors. Among the survivors, standard deviations were too large to make predictions for individual patients. However, when this series is taken as a group, the greater the initial swelling the poorer the outcome. The patient with the lowest PVI (7.2 ml) in the good/moderate outcome category had a delayed intracerebral hematoma which was evacuated. Postoperatively, the PVI of this patient increased toward a normal level. Sev/veg = outcome group with severe disability or in a vegetative state.

References

1.

Avezaat CJJvan Eijndhoven JHMWyper DJ: Cerebrospinal fluid pulse pressure and intracranial volume-pres-sure relationships. J Neurol Neurosurg Psychiatry 42:6877001979Avezaat CJJ van Eijndhoven JHM Wyper DJ: Cerebrospinal fluid pulse pressure and intracranial volume-pres-sure relationships. J Neurol Neurosurg Psychiatry 42:687–700 1979

2.

Becker DPMiller JDWard JDet al: The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:4915021977Becker DP Miller JD Ward JD et al: The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:491–502 1977

3.

Fridén HGEkstedt J: Volume/pressure relationship of the cerebrospinal space in humans. Neurosurgery 13:3513661983Fridén HG Ekstedt J: Volume/pressure relationship of the cerebrospinal space in humans. Neurosurgery 13:351–366 1983

4.

Guillaume JJanny P: Manométrie intracranienne continue: interêt physiopathologique et clinique de al methods. Presse Med 59:9539551951Guillaume J Janny P: Manométrie intracranienne continue: interêt physiopathologique et clinique de al methods. Presse Med 59:953–955 1951

5.

Hase UReulen HJMeinig Get al: The influence of the decompressive operation on the intracranial pressure and the pressure-volume relation in patients with severe head injuries. Acta Neurol 45:1131978Hase U Reulen HJ Meinig G et al: The influence of the decompressive operation on the intracranial pressure and the pressure-volume relation in patients with severe head injuries. Acta Neurol 45:1–13 1978

6.

Jennett BBond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:4804841975Jennett B Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484 1975

7.

Johnston IHJennett B: The place of continuous intracranial pressure monitoring in neurosurgical practice. Acta Neurochir 29:53631973Johnston IH Jennett B: The place of continuous intracranial pressure monitoring in neurosurgical practice. Acta Neurochir 29:53–63 1973

8.

Kosteljanetz M: Acute head injury: pressure-volume relations and cerebrospinal fluid dynamics. Neurosurgery 18:17241986Kosteljanetz M: Acute head injury: pressure-volume relations and cerebrospinal fluid dynamics. Neurosurgery 18:17–24 1986

9.

Langfitt TW: Increased intracranial pressure. Clin Neurosurg 16:4364711969Langfitt TW: Increased intracranial pressure. Clin Neurosurg 16:436–471 1969

10.

Leech PMiller JD: Intracranial volume-pressure relationships during experimental brain compression in primates. 1. Pressure responses to changes in ventricular volume. J Neurol Neurosurg Psychiatry 37:109310981974Leech P Miller JD: Intracranial volume-pressure relationships during experimental brain compression in primates. 1. Pressure responses to changes in ventricular volume. J Neurol Neurosurg Psychiatry 37:1093–1098 1974

11.

Löfgren JZwetnow NN: Cranial and spinal components of the cerebrospinal fluid pressure-volume curve. Acta Neurol Scand 49:5755851973Löfgren J Zwetnow NN: Cranial and spinal components of the cerebrospinal fluid pressure-volume curve. Acta Neurol Scand 49:575–585 1973

12.

Löfgren JZwetnow NN: Influence of a supratentorial expanding mass on intracranial pressure-volume relationships. Acta Neurol Scand 49:5996121973Löfgren J Zwetnow NN: Influence of a supratentorial expanding mass on intracranial pressure-volume relationships. Acta Neurol Scand 49:599–612 1973

13.

Lundberg N: Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand 36 (Suppl 149):11931960Lundberg N: Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand 36 (Suppl 149):1–193 1960

14.

Marmarou AShulman KLaMorgese J: Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J Neurosurg 43:5235341975Marmarou A Shulman K LaMorgese J: Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J Neurosurg 43:523–534 1975

15.

Marmarou AShulman KRosende RM: A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurg 48:3323341978Marmarou A Shulman K Rosende RM: A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurg 48:332–334 1978

16.

Marshall LFSmith RWShapiro HM: The outcome with aggressive treatment in severe head injuries. Part I. The significance of intracranial pressure monitoring. J Neurosurg 50:20251979Marshall LF Smith RW Shapiro HM: The outcome with aggressive treatment in severe head injuries. Part I. The significance of intracranial pressure monitoring. J Neurosurg 50:20–25 1979

17.

Miller JDButterworth JFGudeman SKet al: Further experience in the management of severe head injury. J Neurosurg 54:2892991981Miller JD Butterworth JF Gudeman SK et al: Further experience in the management of severe head injury. J Neurosurg 54:289–299 1981

18.

Miller JDLeech P: Effects of mannitol and steroid therapy on intracranial volume-pressure relationships in patients. J Neurosurg 42:2742811975Miller JD Leech P: Effects of mannitol and steroid therapy on intracranial volume-pressure relationships in patients. J Neurosurg 42:274–281 1975

19.

Miller JDPickard JD: Intracranial volume/pressure studies in patients with head injury. Injury 5:2652681974Miller JD Pickard JD: Intracranial volume/pressure studies in patients with head injury. Injury 5:265–268 1974

20.

Miller JDSullivan HG: Severe intracranial hypertension. Int Anesthesiol Clin 17 (2):19751979Miller JD Sullivan HG: Severe intracranial hypertension. Int Anesthesiol Clin 17(2):19–75 1979

21.

Narayan RKKishore PRSBecker DPet al: Intracranial pressure: to monitor or not to monitor? A review of our experience with head injury. J Neurosurg 56:6506591982Narayan RK Kishore PRS Becker DP et al: Intracranial pressure: to monitor or not to monitor? A review of our experience with head injury. J Neurosurg 56:650–659 1982

22.

Pitts LHKaktis JVJuster Ret al: ICP and outcome in patients with severe head injury in Shulman KMarmarou AMiller JDet al (eds): Intracranial Pressure IV. Berlin: Springier-Verlag1980 pp 59Pitts LH Kaktis JV Juster R et al: ICP and outcome in patients with severe head injury in Shulman K Marmarou A Miller JD et al (eds): Intracranial Pressure IV. Berlin: Springier-Verlag 1980 pp 5–9

23.

Saul TGDucker TB: Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J Neurosurg 56:4985031982Saul TG Ducker TB: Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J Neurosurg 56:498–503 1982

24.

Shapiro KMarmarou A: Clinical applications of the pressure-volume index in treatment of pediatric head injuries. J Neurosurg 56:8198251982Shapiro K Marmarou A: Clinical applications of the pressure-volume index in treatment of pediatric head injuries. J Neurosurg 56:819–825 1982

25.

Shapiro KMarmarou AShulman K: Characterization of clinical CSF dynamics and neural axis compliance using the pressure-volume index: I. The normal pressure-volume index. Ann Neurol 7:5085141980Shapiro K Marmarou A Shulman K: Characterization of clinical CSF dynamics and neural axis compliance using the pressure-volume index: I. The normal pressure-volume index. Ann Neurol 7:508–514 1980

26.

Sullivan HGMiller JDBecker DPet al: The physiological basis of intracranial pressure change with progressive epidural brain compression. An experimental evaluation in cats. J Neurosurg 47:5325501977Sullivan HG Miller JD Becker DP et al: The physiological basis of intracranial pressure change with progressive epidural brain compression. An experimental evaluation in cats. J Neurosurg 47:532–550 1977

27.

Sullivan HGMiller JDGriffith RLet al: CSF pressure-volume dynamics in neurosurgical patients: a preliminary evaluation in six patients. Surg Neurol 9:47541978Sullivan HG Miller JD Griffith RL et al: CSF pressure-volume dynamics in neurosurgical patients: a preliminary evaluation in six patients. Surg Neurol 9:47–54 1978

28.

Tans JTJPoortvliet DCJ: Intracranial volume-pressure relationship in man. Part 2: Clinical significance of the pressure-volume index. J Neurosurg 59:8108161983Tans JTJ Poortvliet DCJ: Intracranial volume-pressure relationship in man. Part 2: Clinical significance of the pressure-volume index. J Neurosurg 59:810–816 1983

29.

Teasdale GJennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81841974Teasdale G Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84 1974

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