title: "Solid Red Line": An Observational Study on Death from Refractory Intracranial Hypertension.
abstract: The index of cerebrovascular pressure reactivity (PRx) correlates independently with outcome after traumatic brain injury (TBI). However, as an index plotted in the time domain, PRx is rather noisy. To "organise" PRx and make its interpretation easier, the colour coding of values, with green when PRx <0 and red when PRx> 0.3, has been introduced as a horizontal colour bar on the ICM+ screen. In rare cases of death from refractory intracranial hypertension, an increase in intracranial pressure (ICP) is commonly preceded by values of PRx >0.3, showing a "solid red line".Twenty patients after TBI and one after traumatic subarachnoid haemorrhage (SAH) from six centres in Europe and Australia have been studied. All of them died in a scenario of refractory intracranial hypertension. In the majority of cases the initial ICP was below 20 mmHg and finally increased to values well above 60 mmHg, resulting in cerebral perfusion pressure less than 20 mmHg. In three cases initial ICP was elevated at the start of monitoring. A solid red line was observed in all cases preceding an increase in ICP above 25 mmHg by minutes to hours and in two cases by 2 and 3 days, respectively. If a solid red line is observed over a prolonged period, it should be considered as an indicator of deep cerebrovascular deterioration.
authors.affiliation: Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
authors.forename: M
authors.initials: M
authors.lastname: Czosnyka
authors.affiliation: Intensive Care, University Hospital Groningen, Groningen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Aries
authors.affiliation: Intensive Care, University Hospital Groningen, Groningen, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Weersink
authors.affiliation: Neurosurgery, "Charite" Hospital, Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Wolf
authors.affiliation: Intensive Care, University Hospital Groningen, Groningen, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Budohoski
authors.affiliation: Intensive Care, Sao Jao, University of Porto, Porto, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Dias
authors.affiliation: Neurosurgery, Alfred Hospital, Melbourne, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Lewis
authors.affiliation: Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK. PS10011@cam.ac.uk.
authors.forename: P
authors.initials: P
authors.lastname: Smielewski
authors.affiliation: Intensive Care, University Hospital, Tromso, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Kordasti
mesh_terms: D000328:Adult; D062186:Arterial Pressure; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008991:Monitoring, Physiologic; D011379:Prognosis; D063177:Pulse Wave Analysis; D020206:Subarachnoid Hemorrhage, Traumatic / Q000150:complications / Q000503:physiopathology*; D055815:Young Adult
keywords: Brain injury; Cerebrovascular pressure reactivity; Intracranial pressure; Pulse waveform amplitude