Methodological Consideration on Monitoring Refractory Intracranial Hypertension and Autonomic Nervous System Activity

Marta Fedriga; András Czigler; Nathalie Nasr; Frederick A Zeiler; Erta Beqiri; Stefan Wolf; Shirin K Frisvolf; Peter Smielewski; Marek Czosnyka

doi:10.1007/978-3-030-59436-7_41

Methodological Consideration on Monitoring Refractory Intracranial Hypertension and Autonomic Nervous System Activity

Acta Neurochir Suppl. 2021:131:211-215. doi: 10.1007/978-3-030-59436-7_41.

Authors

Marta Fedriga^{1

2}, András Czigler^{3

4}, Nathalie Nasr⁵, Frederick A Zeiler^{6

7

8

9}, Erta Beqiri^{3

10}, Stefan Wolf¹¹, Shirin K Frisvolf¹², Peter Smielewski³, Marek Czosnyka³

Affiliations

¹ Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK. marta.fedriga@gmail.com.
² Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy. marta.fedriga@gmail.com.
³ Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
⁴ Department of Neurosurgery and Szentagothai Research Center, University of Pecs, Pecs, Hungary.
⁵ Département de Neurologie CHU de Toulouse, Université de Toulouse III, Toulouse, France.
⁶ Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
⁷ Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
⁸ Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada.
⁹ Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK.
¹⁰ Department of Physiology and Transplantation, Milan University, Milan, Italy.
¹¹ Department of Neurosurgery Charite Hospital, Berlin, Germany.
¹² Department of Intensive Care, University Hospital, Tromso, Norway.

PMID: 33839847
DOI: 10.1007/978-3-030-59436-7_41

Abstract

Refractory intracranial hypertension (RIH) refers to a dramatic increase in intracranial pressure (ICP) that cannot be controlled by treatment and leads to patient death. Detrimental sequelae of raised ICP in acute brain injury (ABI) are unclear because the underlying physiopathological mechanisms of raised ICP have not been sufficiently investigated. Recent reports have shown that autonomic activity is altered during changes in ICP. The aim of our study was to evaluate the feasibility of assessing autonomic activity during RIH with our adopted methodology. We selected 24 ABI patients for retrospective review who developed RIH. They were monitored based on ICP, arterial blood pressure, and electrocardiogram using ICM+ software. Secondary parameters reflecting autonomic activity were computed in time and frequency domains through the continuous measurement of heart rate variability and baroreflex sensitivity. The results of the analysis will be presented later in a full paper. This preliminary analysis shows the feasibility of the adopted methodology.

Keywords: Autonomic nervous system; Intracranial refractory hypertension; Neuromonitoring.

MeSH terms

Autonomic Nervous System
Brain Injuries*
Humans
Intracranial Hypertension* / diagnosis
Intracranial Hypertension* / etiology
Intracranial Pressure
Monitoring, Physiologic
Retrospective Studies