Cardiac-gated intracranial elastance in a swine model of raised intracranial pressure: A novel method to assess intracranial pressure–volume dynamics

Omer Doron, Ofer Barnea, Nino Stocchetti, Tal Or, Erez Nossek, Guy Rosenthal

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE Previous studies have demonstrated the importance of intracranial elastance; however, methodological difficulties have limited widespread clinical use. Measuring elastance may offer potential benefit in helping to identify patients at risk for untoward intracranial pressure (ICP) elevation from small rises in intracranial volume. The authors sought to develop an easily used method that accounts for the changing ICP that occurs over a cardiac cycle and to assess this method in a large-animal model over a broad range of ICPs. METHODS The authors used their previously described cardiac-gated intracranial balloon pump and swine model of cerebral edema. In the present experiment they measured elastance at 4 points along the cardiac cycle—early systole, peak systole, mid-diastole, and end diastole—by using rapid balloon inflation to 1 ml over an ICP range of 10–30 mm Hg. RESULTS The authors studied 7 swine with increasing cerebral edema. Intracranial elastance rose progressively with increasing ICP. Peak-systolic and end-diastolic elastance demonstrated the most consistent rise in elastance as ICP increased. Cardiac-gated elastance measurements had markedly lower variance within swine compared with non–cardiac-gated measures. The slope of the ICP–elastance curve differed between swine. At ICP between 20 and 25 mm Hg, elastance varied between 8.7 and 15.8 mm Hg/ml, indicating that ICP alone cannot accurately predict intracranial elastance. CONCLUSIONS Measuring intracranial elastance in a cardiac-gated manner is feasible and may offer an improved precision of measure. The authors’ preliminary data suggest that because elastance values may vary at similar ICP levels, ICP alone may not necessarily best reflect the state of intracranial volume reserve capacity. Paired ICP–elastance measurements may offer benefit as an adjunct “early warning monitor” alerting to the risk of untoward ICP elevation in brain-injured patients that is induced by small increases in intracranial volume.

Original languageEnglish
Pages (from-to)1650-1657
Number of pages8
JournalJournal of Neurosurgery
Volume134
Issue number5
DOIs
Publication statusPublished - May 2021

Keywords

  • Cardiac-gated elastance
  • Cerebral edema
  • Intracranial balloon pump
  • Intracranial pressure
  • Swine model
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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