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. 2022 Apr;36(2):569-578.
doi: 10.1007/s10877-021-00688-y. Epub 2021 Mar 16.

Low intracranial pressure variability is associated with delayed cerebral ischemia and unfavorable outcome in aneurysmal subarachnoid hemorrhage

Teodor Svedung Wettervik  1 , Timothy Howells  2 , Anders Hånell  2 , Elisabeth Ronne-Engström  2 , Anders Lewén  2 , Per Enblad  2
Affiliations

Low intracranial pressure variability is associated with delayed cerebral ischemia and unfavorable outcome in aneurysmal subarachnoid hemorrhage

Teodor Svedung Wettervik et al. J Clin Monit Comput. 2022 Apr.

Abstract

Purpose: High intracranial pressure variability (ICPV) is associated with favorable outcome in traumatic brain injury, by mechanisms likely involving better cerebral blood flow regulation. However, less is known about ICPV in aneurysmal subarachnoid hemorrhage (aSAH). In this study, we investigated the explanatory variables for ICPV in aSAH and its association with delayed cerebral ischemia (DCI) and clinical outcome.

Methods: In this retrospective study, 242 aSAH patients, treated at the neurointensive care, Uppsala, Sweden, 2008-2018, with ICP monitoring the first ten days post-ictus were included. ICPV was evaluated on three time scales: (1) ICPV-1 m-ICP slow wave amplitude of wavelengths between 55 and 15 s, (2) ICPV-30 m-the deviation from the mean ICP averaged over 30 min, and (3) ICPV-4 h-the deviation from the mean ICP averaged over 4 h. The ICPV measures were analyzed in the early phase (day 1-3), in the early vasospasm phase (day 4-6.5), and the late vasospasm phase (day 6.5-10).

Results: High ICPV was associated with younger age, reduced intracranial pressure/volume reserve (high RAP), and high blood pressure variability in multiple linear regression analyses for all ICPV measures. DCI was associated with reduced ICPV in both vasospasm phases. High ICPV-1 m in the post-ictal early phase and the early vasospasm phase predicted favorable outcome in multiple logistic regressions, whereas ICPV-30 m and ICPV-4 h in the late vasospasm phase had a similar association.

Conclusions: Higher ICPV may reflect more optimal cerebral vessel activity, as reduced values are associated with an increased risk of DCI and unfavorable outcome after aSAH.

Keywords: Aneurysmal subarachnoid hemorrhage; Clinical outcome; Delayed cerebral ischemia; Intracranial pressure variability; Vasospasm.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Intracranial pressure variability in one aneurysmal subarachnoid hemorrhage patient during six hours. The figure demonstrates the three ICPV measures in one aSAH patient during 6 h. The temporal variation was higher for the very short-term ICPV-1m than the more long-term ICPV-4h
Fig. 2
Fig. 2
Three intracranial pressure variability measures in relation to favorable and unfavorable outcome in aneurysmal subarachnoid hemorrhage. The figure demonstrates the temporal course in the three different ICPV measures in relation to favorable (n = 63) and unfavorable (n = 179) outcome. Mean values with 95% confidence interval (CI)
Fig. 3
Fig. 3
Temporal dynamics in intracranial pressure variability the first 10 days post-ictus—relation to delayed cerebral ischemia that required triple-H treatment. The figure demonstrates the temporal course in the three different ICPV measures for those that required DCI treatment with triple-H (n = 61) and those who did not (n = 181). Mean values with 95% confidence interval (CI)
See this image and copyright information in PMC

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