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Introduction <p>Cerebral compliance describes the pressure–volume relationship within the intracranial space, quantifying the brain’s capacity to accommodate changes in volume before significant increases in intracranial pressure (ICP) occur. The pulse shape index – PSI—classifies the ICP pulse-wave-configuration into 4 categories representing the incremental state of compliance. In this analysis we explore the metric in a cohort of prospectively collected pediatric TBI patients in relation to outcome, physiological parameters, and individual ICP insults.</p> Methodology <p>Data acquired by the prospective observational STARSHIP study which included clinical information, 12-month outcome, and monitoring data from 98 pediatric TBI patients admitted to 10 pediatric intensive care units across the UK was assessed. PSI was calculated and compared using univariable and multivariable analyses, as well as considering their time-trends and relation to individual ICP insults.</p> Results <p>PSI derived metrics were associated with outcomes within univariable analyses, additionally they were associated with ICP, and worse cerebrovascular reactivity (absolute correlation coefficients close to 0.3 for the described metrics). Cross correlation analysis revealed a median delay of 8&#xa0;min for changes in ICP after changes in PSI (95% confidence interval of 7.6 to 8.5&#xa0;min). Higher PSI value before ICP elevations was associated with longer duration and greater magnitude of subsequent ICP insults. Additionally, higher PSI before and faster decrease in PSI after osmotherapy were associated with successful reduction of ICP.</p> Conclusions <p>PSI enhances bedside monitoring of pediatric TBI by enabling dynamic assessment of cerebral compliance. Variations in PSI appear to precede subsequent ICP insults and are associated with their severity, thereby potentially facilitating timely interventions. Furthermore, assessing the PSI level before administering osmotherapy may allow gauging treatment success.</p>

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The value of dynamic cerebral compliance monitoring after pediatric traumatic brain injury: a STARSHIP study sub-analysis

  • 期刊论文

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  • 发表日期：

    2025年6月2日

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  • Stefan Yu Bögli,
  • Ihsane Olakorede,
  • Claudia Ann Smith,
  • Marek Czosnyka,
  • Peter Hutchinson,
  • Shruti Agrawal,
  • Peter Smielewski,
  • Shruti Agrawal,
  • Peter Smielewski,
  • Peter J. Hutchinson,
  • Stefan Yu Bögli,
  • Claudia A. Smith,
  • Carly Tooke,
  • Caroline Payne,
  • Holly Belfield,
  • Amisha Mistry,
  • Collette Spencer,
  • Claire Jennings,
  • Lara Bunni,
  • Laura Anderson,
  • Emily Morgan,
  • Melanie James,
  • Rebecca Beckley,
  • Tahnima Khatun,
  • Hafiza Khatun,
  • Olivia Nugent,
  • Richard Aldridge,
  • Ruth Morgan,
  • Julie Morcombe,
  • Martin Quinton,
  • Catherine Postlethwaite,
  • Jenny Pond,
  • Jessica Cutler,
  • Caitlin Oxford,
  • Marek Czosnyka,
  • Michal Placek,
  • Manuel Cabaleira,
  • Deborah White,
  • Esther Daubney,
  • Adam Young,
  • Erta Beqiri,
  • Riaz Kayani,
  • Roddy O’DonneII,
  • Nazima Pathan,
  • Suzanna Watson,
  • Anna Maw,
  • Matthew Garnett,
  • Hari Krishnan Kanthimathinathan,
  • Harish Bangalore,
  • Santosh Sundararajan,
  • Gayathri Subramanian,
  • Dusan Raffaj,
  • Simona Lampariello,
  • Avishay Sarfatti,
  • Anton Mayer,
  • Oliver Ross

摘要

Introduction

Cerebral compliance describes the pressure–volume relationship within the intracranial space, quantifying the brain’s capacity to accommodate changes in volume before significant increases in intracranial pressure (ICP) occur. The pulse shape index – PSI—classifies the ICP pulse-wave-configuration into 4 categories representing the incremental state of compliance. In this analysis we explore the metric in a cohort of prospectively collected pediatric TBI patients in relation to outcome, physiological parameters, and individual ICP insults.

Methodology

Data acquired by the prospective observational STARSHIP study which included clinical information, 12-month outcome, and monitoring data from 98 pediatric TBI patients admitted to 10 pediatric intensive care units across the UK was assessed. PSI was calculated and compared using univariable and multivariable analyses, as well as considering their time-trends and relation to individual ICP insults.

Results

PSI derived metrics were associated with outcomes within univariable analyses, additionally they were associated with ICP, and worse cerebrovascular reactivity (absolute correlation coefficients close to 0.3 for the described metrics). Cross correlation analysis revealed a median delay of 8 min for changes in ICP after changes in PSI (95% confidence interval of 7.6 to 8.5 min). Higher PSI value before ICP elevations was associated with longer duration and greater magnitude of subsequent ICP insults. Additionally, higher PSI before and faster decrease in PSI after osmotherapy were associated with successful reduction of ICP.

Conclusions

PSI enhances bedside monitoring of pediatric TBI by enabling dynamic assessment of cerebral compliance. Variations in PSI appear to precede subsequent ICP insults and are associated with their severity, thereby potentially facilitating timely interventions. Furthermore, assessing the PSI level before administering osmotherapy may allow gauging treatment success.