Plateau waves in head injured patients requiring neurocritical care

Gianluca Castellani; Christian Zweifel; Dong Joo Kim; Emmanuel Carrera; Danila K. Radolovich; Piotr Smielewski; Peter J. Hutchinson; John D. Pickard; Marek Czosnyka

doi:10.1007/s12028-009-9235-7

Plateau waves in head injured patients requiring neurocritical care

Gianluca Castellani
, Christian Zweifel
, Dong Joo Kim
, Emmanuel Carrera
, Danila K. Radolovich
, Piotr Smielewski
, Peter J. Hutchinson
, John D. Pickard
, Marek Czosnyka^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

58 Citations (Scopus)

Abstract

Object: Plateau waves often develop in neurointensive care patients. They are sudden increases in intracranial pressure (ICP) that lead to dramatic decreases of cerebral perfusion pressure (CPP) and can therefore contribute to ischemic secondary brain insult. The aim of this study was to analyze the occurrence of plateau waves in head injured patients requiring neurocritical care, their relation with cerebral autoregulation and impact on outcome. Methods: Data were analyzed retrospectively in 444 head injured patients admitted to Neuroscience Critical Care Unit of Addenbrooke's Hospital in Cambridge, UK. Arterial blood pressure (ABP), intracranial pressure (ICP), heart rate (HR) were digitally recorded and derived indices calculated. Primary monitoring data, autoregulation indices, outcome of patients, initial CT findings (in a subgroup of patients), brain tissue monitoring data (in a subgroup) were compared between patients who developed plateau waves and those who did not. Results: Plateau waves were observed in 109/444 patients (24.5%). They were significantly more frequent in younger patients. Impaired cerebrovascular pressure reactivity and depleted compensatory reserve were associated with vasodilatation on the top of the wave. Plateau waves were not associated with poorer outcome unless the episodes lasted for a long time (longer than 30-40 min). Plateau waves were more frequently seen in patients with lesser midline shift, lower volume of contusion on CT scan, absence of skull fractures, and lower brain tissue concentration of carbon dioxide. Conclusions: Plateau waves are frequent phenomenon. They are not associated with worse outcome unless they lead to sustained intracranial hypertension.

Original language	English
Pages (from-to)	143-150
Number of pages	8
Journal	Neurocritical Care
Volume	11
Issue number	2
DOIs	https://doi.org/10.1007/s12028-009-9235-7
Publication status	Published - 2009 Oct
Externally published	Yes

Bibliographical note

Funding Information:
Acknowledgment The authors are in debt to all the team participating in data collection: Mrs. Pippa Al-Rawi, Mrs. Helen Seley, Mrs. Carole Turner, Dr. Marcella Balestreri, Dr. Magda Hiler, Dr. Luzius Steiner, Dr. Eric Schmidt, Dr. Stefan Piechnik, Dr. Andreas Raabe, Mr. Eric Guazzo, Dr. David Menon, Dr. Arun Gupta, Dr. Basil Matta, Mr. Peter Kirkpatrick, Mr. Ivan Timofyeyev, Mr. Pwawanjit Minhas, Mr. Rodney Laing, and all nursing and research staff of NCCU and Wolfson Brain Imaging Centre. The project was supported by National institute of Health Research Biomedical Research center, Cambridge University Hospital Foundation Trust—Neurosciences Theme. Further support was achieved from the Swiss National Science Foundation (PBBSP3-125550 to CZ and PASSMP3-124262 to EC), Bern, Switzerland. EC was additionally supported by the SICPA Foundation, Lausanne, Switzerland.

Keywords

Cerebral autoregulation
Cerebral perfusion pressure
Intracranial pressure
Plateau waves
TBI outcome
Traumatic brain injury

ASJC Scopus subject areas

Clinical Neurology
Critical Care and Intensive Care Medicine

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10.1007/s12028-009-9235-7

Cite this

@article{f6093ffe60804f078fc2c28ed44d9711,

title = "Plateau waves in head injured patients requiring neurocritical care",

abstract = "Object: Plateau waves often develop in neurointensive care patients. They are sudden increases in intracranial pressure (ICP) that lead to dramatic decreases of cerebral perfusion pressure (CPP) and can therefore contribute to ischemic secondary brain insult. The aim of this study was to analyze the occurrence of plateau waves in head injured patients requiring neurocritical care, their relation with cerebral autoregulation and impact on outcome. Methods: Data were analyzed retrospectively in 444 head injured patients admitted to Neuroscience Critical Care Unit of Addenbrooke's Hospital in Cambridge, UK. Arterial blood pressure (ABP), intracranial pressure (ICP), heart rate (HR) were digitally recorded and derived indices calculated. Primary monitoring data, autoregulation indices, outcome of patients, initial CT findings (in a subgroup of patients), brain tissue monitoring data (in a subgroup) were compared between patients who developed plateau waves and those who did not. Results: Plateau waves were observed in 109/444 patients (24.5\%). They were significantly more frequent in younger patients. Impaired cerebrovascular pressure reactivity and depleted compensatory reserve were associated with vasodilatation on the top of the wave. Plateau waves were not associated with poorer outcome unless the episodes lasted for a long time (longer than 30-40 min). Plateau waves were more frequently seen in patients with lesser midline shift, lower volume of contusion on CT scan, absence of skull fractures, and lower brain tissue concentration of carbon dioxide. Conclusions: Plateau waves are frequent phenomenon. They are not associated with worse outcome unless they lead to sustained intracranial hypertension.",

keywords = "Cerebral autoregulation, Cerebral perfusion pressure, Intracranial pressure, Plateau waves, TBI outcome, Traumatic brain injury",

author = "Gianluca Castellani and Christian Zweifel and Kim, \{Dong Joo\} and Emmanuel Carrera and Radolovich, \{Danila K.\} and Piotr Smielewski and Hutchinson, \{Peter J.\} and Pickard, \{John D.\} and Marek Czosnyka",

note = "Funding Information: Acknowledgment The authors are in debt to all the team participating in data collection: Mrs. Pippa Al-Rawi, Mrs. Helen Seley, Mrs. Carole Turner, Dr. Marcella Balestreri, Dr. Magda Hiler, Dr. Luzius Steiner, Dr. Eric Schmidt, Dr. Stefan Piechnik, Dr. Andreas Raabe, Mr. Eric Guazzo, Dr. David Menon, Dr. Arun Gupta, Dr. Basil Matta, Mr. Peter Kirkpatrick, Mr. Ivan Timofyeyev, Mr. Pwawanjit Minhas, Mr. Rodney Laing, and all nursing and research staff of NCCU and Wolfson Brain Imaging Centre. The project was supported by National institute of Health Research Biomedical Research center, Cambridge University Hospital Foundation Trust—Neurosciences Theme. Further support was achieved from the Swiss National Science Foundation (PBBSP3-125550 to CZ and PASSMP3-124262 to EC), Bern, Switzerland. EC was additionally supported by the SICPA Foundation, Lausanne, Switzerland.",

year = "2009",

month = oct,

doi = "10.1007/s12028-009-9235-7",

language = "English",

volume = "11",

pages = "143--150",

journal = "Neurocritical Care",

issn = "1541-6933",

publisher = "Springer",

number = "2",

}

TY - JOUR

T1 - Plateau waves in head injured patients requiring neurocritical care

AU - Castellani, Gianluca

AU - Zweifel, Christian

AU - Kim, Dong Joo

AU - Carrera, Emmanuel

AU - Radolovich, Danila K.

AU - Smielewski, Piotr

AU - Hutchinson, Peter J.

AU - Pickard, John D.

AU - Czosnyka, Marek

N1 - Funding Information: Acknowledgment The authors are in debt to all the team participating in data collection: Mrs. Pippa Al-Rawi, Mrs. Helen Seley, Mrs. Carole Turner, Dr. Marcella Balestreri, Dr. Magda Hiler, Dr. Luzius Steiner, Dr. Eric Schmidt, Dr. Stefan Piechnik, Dr. Andreas Raabe, Mr. Eric Guazzo, Dr. David Menon, Dr. Arun Gupta, Dr. Basil Matta, Mr. Peter Kirkpatrick, Mr. Ivan Timofyeyev, Mr. Pwawanjit Minhas, Mr. Rodney Laing, and all nursing and research staff of NCCU and Wolfson Brain Imaging Centre. The project was supported by National institute of Health Research Biomedical Research center, Cambridge University Hospital Foundation Trust—Neurosciences Theme. Further support was achieved from the Swiss National Science Foundation (PBBSP3-125550 to CZ and PASSMP3-124262 to EC), Bern, Switzerland. EC was additionally supported by the SICPA Foundation, Lausanne, Switzerland.

PY - 2009/10

Y1 - 2009/10

N2 - Object: Plateau waves often develop in neurointensive care patients. They are sudden increases in intracranial pressure (ICP) that lead to dramatic decreases of cerebral perfusion pressure (CPP) and can therefore contribute to ischemic secondary brain insult. The aim of this study was to analyze the occurrence of plateau waves in head injured patients requiring neurocritical care, their relation with cerebral autoregulation and impact on outcome. Methods: Data were analyzed retrospectively in 444 head injured patients admitted to Neuroscience Critical Care Unit of Addenbrooke's Hospital in Cambridge, UK. Arterial blood pressure (ABP), intracranial pressure (ICP), heart rate (HR) were digitally recorded and derived indices calculated. Primary monitoring data, autoregulation indices, outcome of patients, initial CT findings (in a subgroup of patients), brain tissue monitoring data (in a subgroup) were compared between patients who developed plateau waves and those who did not. Results: Plateau waves were observed in 109/444 patients (24.5%). They were significantly more frequent in younger patients. Impaired cerebrovascular pressure reactivity and depleted compensatory reserve were associated with vasodilatation on the top of the wave. Plateau waves were not associated with poorer outcome unless the episodes lasted for a long time (longer than 30-40 min). Plateau waves were more frequently seen in patients with lesser midline shift, lower volume of contusion on CT scan, absence of skull fractures, and lower brain tissue concentration of carbon dioxide. Conclusions: Plateau waves are frequent phenomenon. They are not associated with worse outcome unless they lead to sustained intracranial hypertension.

AB - Object: Plateau waves often develop in neurointensive care patients. They are sudden increases in intracranial pressure (ICP) that lead to dramatic decreases of cerebral perfusion pressure (CPP) and can therefore contribute to ischemic secondary brain insult. The aim of this study was to analyze the occurrence of plateau waves in head injured patients requiring neurocritical care, their relation with cerebral autoregulation and impact on outcome. Methods: Data were analyzed retrospectively in 444 head injured patients admitted to Neuroscience Critical Care Unit of Addenbrooke's Hospital in Cambridge, UK. Arterial blood pressure (ABP), intracranial pressure (ICP), heart rate (HR) were digitally recorded and derived indices calculated. Primary monitoring data, autoregulation indices, outcome of patients, initial CT findings (in a subgroup of patients), brain tissue monitoring data (in a subgroup) were compared between patients who developed plateau waves and those who did not. Results: Plateau waves were observed in 109/444 patients (24.5%). They were significantly more frequent in younger patients. Impaired cerebrovascular pressure reactivity and depleted compensatory reserve were associated with vasodilatation on the top of the wave. Plateau waves were not associated with poorer outcome unless the episodes lasted for a long time (longer than 30-40 min). Plateau waves were more frequently seen in patients with lesser midline shift, lower volume of contusion on CT scan, absence of skull fractures, and lower brain tissue concentration of carbon dioxide. Conclusions: Plateau waves are frequent phenomenon. They are not associated with worse outcome unless they lead to sustained intracranial hypertension.

KW - Cerebral autoregulation

KW - Cerebral perfusion pressure

KW - Intracranial pressure

KW - Plateau waves

KW - TBI outcome

KW - Traumatic brain injury

UR - https://www.scopus.com/pages/publications/70350565429

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DO - 10.1007/s12028-009-9235-7

M3 - Article

C2 - 19565359

AN - SCOPUS:70350565429

SN - 1541-6933

VL - 11

SP - 143

EP - 150

JO - Neurocritical Care

JF - Neurocritical Care

IS - 2

ER -

Plateau waves in head injured patients requiring neurocritical care

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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