Document Detail


Model-based noninvasive estimation of intracranial pressure from cerebral blood flow velocity and arterial pressure.
MedLine Citation:
PMID:  22496546     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Intracranial pressure (ICP) is affected in many neurological conditions. Clinical measurement of pressure on the brain currently requires placing a probe in the cerebrospinal fluid compartment, the brain tissue, or other intracranial space. This invasiveness limits the measurement to critically ill patients. Because ICP is also clinically important in conditions ranging from brain tumors and hydrocephalus to concussions, noninvasive determination of ICP would be desirable. Our model-based approach to continuous estimation and tracking of ICP uses routinely obtainable time-synchronized, noninvasive (or minimally invasive) measurements of peripheral arterial blood pressure and blood flow velocity in the middle cerebral artery (MCA), both at intra-heartbeat resolution. A physiological model of cerebrovascular dynamics provides mathematical constraints that relate the measured waveforms to ICP. Our algorithm produces patient-specific ICP estimates with no calibration or training. Using 35 hours of data from 37 patients with traumatic brain injury, we generated ICP estimates on 2665 nonoverlapping 60-beat data windows. Referenced against concurrently recorded invasive parenchymal ICP that varied over 100 millimeters of mercury (mmHg) across all records, our estimates achieved a mean error (bias) of 1.6 mmHg and SD of error (SDE) of 7.6 mmHg. For the 1673 data windows over 22 hours in which blood flow velocity recordings were available from both the left and the right MCA, averaging the resulting bilateral ICP estimates reduced the bias to 1.5 mmHg and SDE to 5.9 mmHg. This accuracy is already comparable to that of some invasive ICP measurement methods in current clinical use.
Authors:
Faisal M Kashif; George C Verghese; Vera Novak; Marek Czosnyka; Thomas Heldt
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Science translational medicine     Volume:  4     ISSN:  1946-6242     ISO Abbreviation:  Sci Transl Med     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-04-12     Completed Date:  2012-08-01     Revised Date:  2014-05-12    
Medline Journal Info:
Nlm Unique ID:  101505086     Medline TA:  Sci Transl Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  129ra44     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Algorithms
Blood Pressure / physiology*
Cerebrovascular Circulation / physiology*
Humans
Intracranial Pressure / physiology*
Male
Models, Biological
Young Adult
Grant Support
ID/Acronym/Agency:
4P30 AG02871702/AG/NIA NIH HHS; 4R37 AG2537-05/AG/NIA NIH HHS; P30 AG028717/AG/NIA NIH HHS; R01 EB001659/EB/NIBIB NIH HHS; R01 EB001659/EB/NIBIB NIH HHS; R37 AG025037/AG/NIA NIH HHS
Comments/Corrections
Comment In:
Sci Transl Med. 2012 Apr 11;4(129):129fs6   [PMID:  22496544 ]

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