OBJECTIVE: Critical closing pressure (CCP) is the arterial pressure below which the vessels collapse. Hypothetically it is the sum of intracranial pressure (ICP) and vessel wall tension in the cerebral circulation. This study investigated transhemispherical asymmetry of CCP by studying its correlation with radiological findings on computed tomography (CT) scans in head injury patients. METHOD: ICP, arterial blood pressure, and middle cerebral artery blood flow velocity were recorded daily in 119 ventilated patients. Waveforms were processed to calculate CCP. CT scans were analysed according to a system based on the Marshall classification. RESULTS: Left-right differences in CCP correlated with midline shift on the CT scan (r = 0.48; p<0.02). Asymmetry of CCP also corresponded with the side of the head lesion (p<0.007) and the side of the craniotomy where it was performed (p<0.006). Absolute CCP weakly correlated with brain swelling (r = -0.23; p<0.03) and arterial pressure (r = 0.21; p<0.02) but did not correlate with ICP. Cerebral perfusion pressure calculated as the difference between mean arterial pressure and CCP did not correlate with outcome, but "traditional" cerebral perfusion pressure (mean arterial pressure minus intracranial pressure) did. CONCLUSIONS: Critical closing pressure is disturbed by localised brain lesions. Its asymmetry corresponds to asymmetrical findings on CT scans. CCP seems to describe vascular resistance better than ICP.
OBJECTIVE: Critical closing pressure (CCP) is the arterial pressure below which the vessels collapse. Hypothetically it is the sum of intracranial pressure (ICP) and vessel wall tension in the cerebral circulation. This study investigated transhemispherical asymmetry of CCP by studying its correlation with radiological findings on computed tomography (CT) scans in head injury patients. METHOD: ICP, arterial blood pressure, and middle cerebral artery blood flow velocity were recorded daily in 119 ventilated patients. Waveforms were processed to calculate CCP. CT scans were analysed according to a system based on the Marshall classification. RESULTS: Left-right differences in CCP correlated with midline shift on the CT scan (r = 0.48; p<0.02). Asymmetry of CCP also corresponded with the side of the head lesion (p<0.007) and the side of the craniotomy where it was performed (p<0.006). Absolute CCP weakly correlated with brain swelling (r = -0.23; p<0.03) and arterial pressure (r = 0.21; p<0.02) but did not correlate with ICP. Cerebral perfusion pressure calculated as the difference between mean arterial pressure and CCP did not correlate with outcome, but "traditional" cerebral perfusion pressure (mean arterial pressure minus intracranial pressure) did. CONCLUSIONS: Critical closing pressure is disturbed by localised brain lesions. Its asymmetry corresponds to asymmetrical findings on CT scans. CCP seems to describe vascular resistance better than ICP.
Authors: Hiren C Patel; David K Menon; Susan Tebbs; Rebecca Hawker; Peter J Hutchinson; Peter J Kirkpatrick Journal: Intensive Care Med Date: 2002-02-14 Impact factor: 17.440
Authors: Eric A Schmidt; Stefan K Piechnik; Piotr Smielewski; Andreas Raabe; Basil F Matta; Marek Czosnyka Journal: J Neuroimaging Date: 2003-07 Impact factor: 2.486
Authors: Eric A Schmidt; Marek Czosnyka; Luzius A Steiner; Marcella Balestreri; Piotr Smielewski; Stefan K Piechnik; Basil F Matta; John D Pickard Journal: J Neurosurg Date: 2003-12 Impact factor: 5.115
Authors: I Gooskens; E A Schmidt; M Czosnyka; St K Piechnik; P Smielewski; P J Kirkpatrick; J D Pickard Journal: Acta Neurochir (Wien) Date: 2003-07 Impact factor: 2.216
Authors: Jatinder S Minhas; William Rook; Ronney B Panerai; Ryan L Hoiland; Phil N Ainslie; Jonathan P Thompson; Amit K Mistri; Thompson G Robinson Journal: Br J Anaesth Date: 2019-12-06 Impact factor: 9.166
Authors: Monica S Vavilala; Nuj Tontisirin; Yuthana Udomphorn; William Armstead; Jerry J Zimmerman; Randall Chesnut; Arthur M Lam Journal: Neurocrit Care Date: 2008 Impact factor: 3.210
Authors: Georgios V Varsos; Karol P Budohoski; Angelos G Kolias; Xiuyun Liu; Peter Smielewski; Vassilis G Varsos; Peter J Hutchinson; John D Pickard; Marek Czosnyka Journal: Neurocrit Care Date: 2014-10 Impact factor: 3.210
Authors: Kun Hu; Men-Tzung Lo; C K Peng; Vera Novak; Eric A Schmidt; Ajay Kumar; Marek Czosnyka Journal: J Neurotrauma Date: 2009-02-11 Impact factor: 5.269