Abstract：
Continuous monitoring of mean intracranial pressure (ICP) has been an essential part of neurocritical care for more than half a century. Cerebrospinal pressure-volume compensation, i.e. the ability of the cerebrospinal system to buffer changes in volume without substantial increases in ICP, is considered an important factor in preventing adverse effects on the patient\'s condition that are associated with ICP elevation. However, existing assessment methods are poorly suited to the management of brain injured patients as they require external manipulation of intracranial volume. In the 1980s, studies suggested that spontaneous short-term variations in the ICP signal over a single cardiac cycle, called the ICP pulse waveform, may provide information on cerebrospinal compensatory reserve. In this review we discuss the approaches that have been proposed so far to derive this information, from pulse amplitude estimation and spectral techniques to most recent advances in morphological analysis based on artificial intelligence solutions. Each method is presented with focus on its clinical significance and the potential for application in standard clinical practice. Finally, we highlight the missing links that need to be addressed in future studies in order for ICP pulse waveform analysis to achieve widespread use in the neurocritical care setting.
摘要：
半个多世纪以来，连续监测平均颅内压（ICP）一直是神经重症监护的重要组成部分。脑脊液压力-容量补偿，即脑脊液系统在不显著增加ICP的情况下缓冲体积变化的能力，被认为是预防与ICP升高相关的患者病情不良反应的重要因素。然而,现有的评估方法不太适合脑损伤患者的治疗，因为他们需要外部操作的颅内容量。在1980年代，研究表明，ICP信号在单个心动周期内的自发短期变化，称为ICP脉冲波形，可以提供脑脊髓代偿储备的信息。在这篇综述中，我们讨论了迄今为止提出的获得这些信息的方法，从脉冲幅度估计和频谱技术到基于人工智能解决方案的形态学分析的最新进展。每种方法都着重于其临床意义和在标准临床实践中的应用潜力。最后,我们强调了在未来研究中需要解决的缺失环节,以使ICP脉搏波形分析在神经重症监护环境中得到广泛使用.
