Show simple item record

dc.contributor.authorKim, Mi Oken
dc.contributor.authorAdji, Audreyen
dc.contributor.authorO’Rourke, Michael Fen
dc.contributor.authorAvolio, Alberto Pen
dc.contributor.authorSmielewski, Peteren
dc.contributor.authorPickard, Johnen
dc.contributor.authorCzosnyka, Mareken
dc.date.accessioned2015-05-06T15:09:16Z
dc.date.available2015-05-06T15:09:16Z
dc.date.issued2015-04-23en
dc.identifier.citationKim et al. Journal of Hypertension 2015 33(6):1233-41. DOI: 10.1097/HJH.0000000000000539en
dc.identifier.issn0263-6352
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/247532
dc.description.abstractBackground: The brain is highly vascular and richly perfused, and dependent on continuous flow for normal function. Although confined within the skull, pressure within the brain is usually less than 15 mmHg, and shows small pulsations related to arterial pulse under normal circumstances. Pulsatile arterial hemodynamics in the brain have been studied before, but are still inadequately understood, especially during changes of intracranial pressure (ICP) after head injury. Method: In seeking cohesive explanations, we measured ICP and radial artery pressure (RAP) invasively with high-fidelity manometer systems, together with middle cerebral artery flow velocity (MCAFV) (transcranial Doppler) and central aortic pressure (CAP) generated from RAP, using a generalized transfer function technique, in eight young unconscious, ventilated adults following closed head trauma. We focused on vascular effects of spontaneous rises of ICP ('plateau waves'). Results: A rise in mean ICP from 29 to 53 mmHg caused no consistent change in pressure outside the cranium, or in heart rate, but ICP pulsations increased in amplitude from 8 to 20 mmHg, and ICP waveform came to resemble that in the aorta. Cerebral perfusion pressure (=central aortic pressure - ICP), which equates with transmural pressure, fell from 61 to 36 mmHg. Mean MCAFV fell from 53 to 40 cm/s, whereas pulsatile MCAFV increased from 77 to 98 cm/s. These significant changes (all P < 0.01) may be explained using the Monro-Kellie doctrine, because of compression of the brain, as occurs in a limb when external pressure is applied. Conclusion: The findings emphasize importance of reducing ICP, when raised, and on the additional benefits of reducing wave reflection from the lower body.
dc.description.sponsorshipThis study was supported by the National Institute of Health Research, the Biomedical Research Centre (Neuroscience Theme), and the Medical Research Council (Grants G0600986 and G9439390). J.D.P. has received the NIHR Investigator Awards. M.O.K. is sponsored by an Australian Postgraduate Awards Industrial Linkage Grant from the Australian Research Council (LP0884094), with AtCor Medical Australia as the collaborating organization.
dc.languageEnglishen
dc.language.isoenen
dc.publisherWolters Kluwer
dc.subjectaortic pressureen
dc.subjectintracranial pressureen
dc.subjectplateau wavesen
dc.titlePrinciples of cerebral hemodynamics when intracranial pressure is raised: lessons from the peripheral circulationen
dc.typeArticle
dc.description.versionThis is the final version of the article. It first appeared from Wolters Kluwer via http://dx.doi.org/10.1097/HJH.0000000000000539en
prism.endingPage1241
prism.publicationDate2015en
prism.publicationNameJournal of Hypertensionen
prism.startingPage1233
prism.volume33en
dc.rioxxterms.funderNIHR
dc.rioxxterms.funderMRC
dc.rioxxterms.projectidG0600986
dc.rioxxterms.projectidG9439390
rioxxterms.versionofrecord10.1097/HJH.0000000000000539en
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2015-04-23en
dc.contributor.orcidSmielewski, Peter [0000-0001-5096-3938]
dc.contributor.orcidPickard, John [0000-0002-5762-6667]
dc.contributor.orcidCzosnyka, Marek [0000-0003-2446-8006]
dc.identifier.eissn1473-5598
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idMRC (G0600986)
pubs.funder-project-idMRC (G9439390)
pubs.funder-project-idMRC (G0001237)


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record