• Christina Haubrich, Luzius A Steiner, Rolf R Diehl, Magdalena Kasprowicz, Piotr Smielewski, John D Pickard, and Marek Czosnyka.
• Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge, UK. chaubrich@ukaachen.de
• Ultrasound Med Biol. 2013 Sep 1; 39 (9): 1521-6.

AbstractTo anticipate an increase in intra-cranial pressure (ICP), information about pressure-volume (p/v) compliance is required. ICP monitoring often fails at this task after head injury. Could a test that transiently shifts intra-cranial blood volume produce consistent information about the p/v relationship? Doppler flow velocities in the middle cerebral arteries (left: 80.8 ± 34.7 cm/s; right: 65.9 ± 28.0 cm/s) and ICP (16.4 ± 6.7 mm Hg) were measured in 29 patients with head injury, before and during moderate hypocapnia (4.4 ± 3.0 kPa). The ratio of vasomotor response to change in ICP differed between those with high (left: 14.8 ± 6.9, right: 14.4 ± 6.6 cm/s/kPa/mm Hg) and low (left: 1.8 ± 0.6, right: 2.2 ± 0.9 cm/s/kPa/mm g) intra-cranial compliance. Additionally, the ratio identified 12 patients deviating from the classic non-linear p/v curve (left: 5.7 ± 1.3, right: 5.8 ± 1.0 cm/s/kPa/mm Hg). They exhibited an almost proportional relationship between vasomotor and ICP responses (R = 0.69, p < 0.01). Results suggest that a test that combines the responses of two intra-cranial compartments may provide consistent information about intra-cranial p/v compliance, even if the parameters derived from ICP monitoring are inconclusive.Copyright © 2013 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

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