title: Asymmetry of critical closing pressure following head injury.
abstract: OBJECTIVE
  Critical closing pressure (CCP) is the arterial pressure below which the vessels collapse. Hypothetically it is the sum of intracranial pressure (ICP) and vessel wall tension in the cerebral circulation. This study investigated transhemispherical asymmetry of CCP by studying its correlation with radiological findings on computed tomography (CT) scans in head injury patients.
  
  
  METHODS
  ICP, arterial blood pressure, and middle cerebral artery blood flow velocity were recorded daily in 119 ventilated patients. Waveforms were processed to calculate CCP. CT scans were analysed according to a system based on the Marshall classification.
  
  
  RESULTS
  Left-right differences in CCP correlated with midline shift on the CT scan (r = 0.48; p<0.02). Asymmetry of CCP also corresponded with the side of the head lesion (p<0.007) and the side of the craniotomy where it was performed (p<0.006). Absolute CCP weakly correlated with brain swelling (r = -0.23; p<0.03) and arterial pressure (r = 0.21; p<0.02) but did not correlate with ICP. Cerebral perfusion pressure calculated as the difference between mean arterial pressure and CCP did not correlate with outcome, but "traditional" cerebral perfusion pressure (mean arterial pressure minus intracranial pressure) did.
  
  
  CONCLUSIONS
  Critical closing pressure is disturbed by localised brain lesions. Its asymmetry corresponds to asymmetrical findings on CT scans. CCP seems to describe vascular resistance better than ICP.
authors.affiliation: University of Cambridge Clinical School, Addenbrooke's Hospital, UK.
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.forename: E A
authors.initials: EA
authors.lastname: Schmidt
authors.forename: M
authors.initials: M
authors.lastname: Hiler
authors.forename: P
authors.initials: P
authors.lastname: Smielewski
authors.forename: J D
authors.initials: JD
authors.lastname: Pickard
authors.forename: M
authors.initials: M
authors.lastname: Czosnyka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001930:Brain Injuries / Q000175:diagnosis / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D016638:Critical Illness; D005260:Female; D005336:Fiber Optic Technology; D015600:Glasgow Coma Scale; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed