ArticleNeurocritical care2023
Critical Closing Pressure and Cerebrovascular Resistance Responses to Intracranial Pressure Variations in Neurocritical Patients.
Article in Neurocritical care, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Profiling cerebral hemodynamics in sepsis and septic shock patients with transcranial doppler: a systematic review and meta-analysis.Journal of clinical monitoring and computing · 2026Pooled it
- Stable tissue oxygen cerebral perfusion pressure (stoCPP): Proof of concept for a novel method for the assessment of optimum cerebral perfusion pressure in severe traumatic brain injury.Journal of clinical monitoring and computing · 2026Article
- A noninvasive method for assessing optimal cerebral perfusion pressure.Critical care (London, England) · 2026Observational
- Arteriolar Collapse and Haemodynamic Incoherence in Shock: Rethinking Critical Closing Pressure.Journal of personalized medicine · 2026Review
- The impact of posture changes on critical closing pressure and resistance-area product regulation in healthy subjects.European journal of applied physiology · 2026Article
- Prediction of Cerebrospinal Fluid (CSF) Pressure with Generative Adversarial Network Synthetic Plasma-CSF Biomarker Pairing.Neuroinformatics · 2025Article
- Monro-Kellie 4.0: moving from intracranial pressure to intracranial dynamics.Critical care (London, England) · 2025Review
- Machine learning approach for noninvasive intracranial pressure estimation using pulsatile cranial expansion waveforms.NPJ digital medicine · 2025Article
- Association between the postoperative glycemic variability and mortality after craniotomy: a retrospective cohort study and development of a mortality prediction model.Frontiers in endocrinology · 2025Article
- Predicting short-term outcomes in brain-injured patients: a comprehensive approach with transcranial Doppler and intracranial compliance assessment.Journal of clinical monitoring and computing · 2024Article
- A Comprehensive Perspective on Intracranial Pressure Monitoring and Individualized Management in Neurocritical Care: Results of a Survey with Global Experts.Neurocritical care · 2024Article
- Modified Beer-Lambert algorithm to measure pulsatile blood flow, critical closing pressure, and intracranial hypertension.Biomedical optics express · 2024Article
- Impact of different blood pressure targets on cerebral hemodynamics in septic shock: A prospective pilot study protocol-SEPSIS-BRAIN.PloS one · 2024Article
- Point-Counterpoint: Cerebral perfusion pressure is a high-risk concept.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2023Article
- The intracranial compartmental syndrome: a proposed model for acute brain injury monitoring and management.Critical care (London, England) · 2023Review
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Authors and funding
9 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCritical closing pressure (CrCP) and resistance-area product (RAP) have been conceived as compasses to optimize cerebral perfusion pressure (CPP) and monitor cerebrovascular resistance, respectively. However, for patients with acute brain injury (ABI), the impact of intracranial pressure (ICP) variability on these variables is poorly understood. The present study evaluates the effects of a controlled ICP variation on CrCP and RAP among patients with ABI.
methodsConsecutive neurocritical patients with ICP monitoring were included along with transcranial Doppler and invasive arterial blood pressure monitoring. Internal jugular veins compression was performed for 60 s for the elevation of intracranial blood volume and ICP. Patients were separated in groups according to previous intracranial hypertension severity, with either no skull opening (Sk1), neurosurgical mass lesions evacuation, or decompressive craniectomy (DC) (patients with DC [Sk3]).
resultsAmong 98 included patients, the correlation between change (Δ) in ICP and the corresponding ΔCrCP was strong (group Sk1 r = 0.643 [p = 0.0007], group with neurosurgical mass lesions evacuation r = 0.732 [p < 0.0001], and group Sk3 r = 0.580 [p = 0.003], respectively). Patients from group Sk3 presented a significantly higher ΔRAP (p = 0.005); however, for this group, a higher response in mean arterial pressure (change in mean arterial pressure p = 0.034) was observed. Exclusively, group Sk1 disclosed reduction in ICP before internal jugular veins compression withholding.
conclusionsThis study elucidates that CrCP reliably changes in accordance with ICP, being useful to indicate ideal CPP in neurocritical settings. In the early days after DC, cerebrovascular resistance seems to remain elevated, despite exacerbated arterial blood pressure responses in efforts to maintain CPP stable. Patients with ABI with no need of surgical procedures appear to remain with more effective ICP compensatory mechanisms when compared with those who underwent neurosurgical interventions.
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