A noninvasive estimation of cerebral perfusion pressure using critical closing pressure

Georgios V. Varsos*, Angelos G. Kolias, Peter Smielewski, Kenneth Martin Brady, Vassilis G. Varsos, Peter J. Hutchinson, John D. Pickard, Marek Czosnyka

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


OB JECT?Cerebral blood flow is associated with cerebral perfusion pressure (CPP), which is clinically monitored through arterial blood pressure (ABP) and invasive measurements of intracranial pressure (ICP). Based on critical closing pressure (CrCP), the authors introduce a novel method for a noninvasive estimator of CPP (eCPP). METHODS?Data from 280 head-injured patients with ABP, ICP, and transcranial Doppler ultrasonography measurements were retrospectively examined. CrCP was calculated with a noninvasive version of the cerebrovascular impedance method. The eCPP was refined with a predictive regression model of CrCP-based estimation of ICP from known ICP using data from 232 patients, and validated with data from the remaining 48 patients. RESULTS?Cohort analysis showed eCPP to be correlated with measured CPP (R = 0.851, p < 0.001), with a mean ± SD difference of 4.02 ± 6.01 mm Hg, and 83.3% of the cases with an estimation error below 10 mm Hg. eCPP accurately predicted low CPP (< 70 mm Hg) with an area under the curve of 0.913 (95% CI 0.883-0.944). When each recorDing session of a patient was assessed individually, eCPP could predict CPP with a 95% CI of the SD for estimating CPP between multiple recorDing sessions of 1.89-5.01 mm Hg. CONCLUSIO NS?Overall, CrCP-based eCPP was strongly correlated with invasive CPP, with sensitivity and specificity for detection of low CPP that show promise for clinical use.

Original languageEnglish (US)
Pages (from-to)638-648
Number of pages11
JournalJournal of neurosurgery
Issue number3
StatePublished - Sep 2015


  • Cerebral perfusion pressure
  • Critical closing pressure
  • Noninvasive model
  • Transcranial Doppler ultrasonography
  • Vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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