Consistent changes in intracranial pressure waveform morphology induced by acute hypercapnic cerebral vasodilatation

Neurocrit Care. 2011 Aug;15(1):55-62. doi: 10.1007/s12028-010-9463-x.


Background: Intracranial pressure (ICP) remains a pivotal physiological signal for managing brain injury and subarachnoid hemorrhage (SAH) patients in neurocritical care units. Given the vascular origin of the ICP, changes in ICP waveform morphology could be used to infer cerebrovascular changes. Clinical validation of this association in the setting of brain trauma, and SAH is challenging due to the multi-factorial influences on, and uncertainty of, the state of the cerebral vasculature.

Methods: To gain a more controlled setting, in this articel, we study ICP signals recorded in four uninjured patients undergoing a CO2 inhalation challenge in which hypercapnia induced acute cerebral vasodilatation. We apply our morphological clustering and analysis of intracranial pressure (MOCAIP) algorithm to identify six landmarks on individual ICP pulses (based on the three established ICP sub-peaks; P1, P2, and P3) and extract 128 ICP morphological metrics. Then by comparing baseline, test, and post-test data, we assess the consistency and rate of change for each individual metric.

Results: Acute vasodilatation causes consistent changes in a total of 72 ICP pulse morphological metrics and the P2 sub-region responds to cerebral vascular changes in the most consistent way with the greatest change as compared to P1 and P3 sub-regions.

Conclusions: Since the dilation/constriction of the cerebral vasculature resulted in detectable consistent changes in ICP MOCIAP metrics, by an extended monitoring practice of ICP that includes characterizing ICP pulse morphology, one can potentially detect cerebrovascular changes, continuously, for patients under neurocritical care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Algorithms
  • Carbon Dioxide
  • Cerebrovascular Circulation / physiology*
  • Cluster Analysis
  • Cohort Studies
  • Dilatation, Pathologic / complications
  • Dilatation, Pathologic / pathology
  • Dilatation, Pathologic / physiopathology
  • Female
  • Humans
  • Hypercapnia / complications*
  • Hypercapnia / pathology
  • Hypercapnia / physiopathology*
  • Intracranial Pressure / physiology*
  • Middle Aged
  • Time Factors
  • Young Adult


  • Carbon Dioxide