Document Detail

Critical closing pressure determined with a model of cerebrovascular impedance.
MedLine Citation:
PMID:  23149558     Owner:  NLM     Status:  MEDLINE    
Critical closing pressure (CCP) is the arterial blood pressure (ABP) at which brain vessels collapse and cerebral blood flow (CBF) ceases. Using the concept of impedance to CBF, CCP can be expressed with brain-monitoring parameters: cerebral perfusion pressure (CPP), ABP, blood flow velocity (FV), and heart rate. The novel multiparameter method (CCPm) was compared with traditional transcranial Doppler (TCD) calculations of CCP (CCP1). Digital recordings of ABP, intracranial pressure (ICP), and TCD-based FV from previously published studies of 29 New Zealand White rabbits were reanalyzed. Overall, CCP1 and CCPm showed correlation across wide ranges of ABP, ICP, and PaCO2 (R=0.93, P<0.001). Three physiological perturbations were studied: increase in ICP (n=29) causing both CCP1 and CCPm to increase (P<0.001 for both); reduction of ABP (n=10) resulting in decrease of CCP1 (P=0.006) and CCPm (P=0.002); and controlled increase of PaCO2 (n=8) to hypercapnic levels, which decreased CCP1 and CCPm, albeit insignificantly (P=0.123 and P=0.306 respectively), caused by a spontaneous significant increase in ABP (P=0.025). Multiparameter mathematical model of critical closing pressure explains the relationship of CCP on brain-monitoring variables, allowing the estimation of CCP during cases such as hypercapnia-induced hyperemia, where traditional calculations, like CCP1, often reach negative non-physiological values.
Georgios V Varsos; Hugh Richards; Magdalena Kasprowicz; Karol P Budohoski; Ken M Brady; Matthias Reinhard; Alberto Avolio; Peter Smielewski; John D Pickard; Marek Czosnyka
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-11-14
Journal Detail:
Title:  Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism     Volume:  33     ISSN:  1559-7016     ISO Abbreviation:  J. Cereb. Blood Flow Metab.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-01     Completed Date:  2013-03-25     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  8112566     Medline TA:  J Cereb Blood Flow Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  235-43     Citation Subset:  IM    
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MeSH Terms
Blood Flow Velocity
Blood Pressure*
Cerebrovascular Circulation*
Hypercapnia / drug therapy,  physiopathology*
Hyperemia / drug therapy,  physiopathology*
Intracranial Hypertension / drug therapy,  physiopathology*
Intracranial Pressure*
Models, Cardiovascular*
Grant Support
G0600986//Medical Research Council; G9439390//Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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