title: Plateau Waves of Intracranial Pressure and Multimodal Brain Monitoring.
abstract: The aim of this study was to describe multimodal brain monitoring characteristics during plateau waves of intracranial pressure (ICP) in patients with head injury, using ICM+ software for continuous recording. Plateau waves consist of an abrupt elevation of ICP above 40 mmHg for 5-20 min. This is a prospective observational study of patients with head injury who were admitted to a neurocritical care unit and who developed plateau waves. We analyzed 59 plateau waves that occurred in 8 of 18 patients (44 %). At the top of plateau waves arterial blood pressure remained almost constant, but cerebral perfusion pressure, cerebral blood flow, brain tissue oxygenation, and cerebral oximetry decreased. After plateau waves, patients with a previously better autoregulation status developed hyperemia, demonstrated by an increase in cerebral blood flow and brain oxygenation. Pressure and oxygen cerebrovascular reactivity indexes (pressure reactivity index and ORxshort) increased significantly during the plateau wave as a sign of disruption of autoregulation. Bedside multimodal brain monitoring is important to characterize increases in ICP and give differential diagnoses of plateau waves, as management of this phenomenon differs from that of regular ICP.
authors.affiliation: Neurocritical Care Unit, Intensive Care Department, Hospital São Joao, Rua Fonte Velha 938, 4460-731 Custoias MTS, Porto, Portugal. mceleste.dias@gmail.com.
authors.forename: Celeste
authors.initials: C
authors.lastname: Dias
authors.affiliation: Neurocritical Care Unit, Intensive Care Department, Hospital São Joao, Rua Fonte Velha 938, 4460-731 Custoias MTS, Porto, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Maia
authors.affiliation: Neurosurgery Department, Hospital São Joao, Porto, Portugal.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cerejo
authors.affiliation: Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Smielewski
authors.affiliation: Neurocritical Care Unit, Intensive Care Department, Hospital São Joao, Rua Fonte Velha 938, 4460-731 Custoias MTS, Porto, Portugal.
authors.forename: José-Artur
authors.initials: JA
authors.lastname: Paiva
authors.affiliation: Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
authors.forename: Marek
authors.initials: M
authors.lastname: Czosnyka
mesh_terms: D000328:Adult; D062186:Arterial Pressure / Q000502:physiology*; D001921:Brain / Q000378:metabolism*; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D005260:Female; D006706:Homeostasis; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D019586:Intracranial Hypertension / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010092:Oximetry; D010100:Oxygen / Q000378:metabolism*; D011446:Prospective Studies
chemical_list: D010100:Oxygen
keywords: Cerebral blood flow index; Head injury; Intracranial pressure; Multimodal brain monitoring; Plateau waves; Pressure reactivity index; Short oxygen reactivity index