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A Method for Estimating Zero-Flow Pressure and Intracranial Pressure

Marzban, Caren PhD*,†; Illian, Paul R. BS*; Morison, David BS*; Moore, Anne BSN, RVT; Kliot, Michel MD; Czosnyka, Marek PhD§; Mourad, Pierre D. PhD*,‡,∥

Journal of Neurosurgical Anesthesiology: January 2013 - Volume 25 - Issue 1 - p 25–32
doi: 10.1097/ANA.0b013e318263c295
Clinical Investigations

Background: It has been hypothesized that the critical closing pressure of cerebral circulation, or zero-flow pressure (ZFP), can estimate intracranial pressure (ICP). One ZFP estimation method used extrapolation of arterial blood pressure as against blood-flow velocity. The aim of this study was to improve ICP predictions.

Methods: Two revisions have been considered: (1) the linear model used for extrapolation is extended to a nonlinear equation; and (2) the parameters of the model are estimated by an alternative criterion (not least squares). The method is applied to data on transcranial Doppler measurements of blood-flow velocity, arterial blood pressure, and ICP from 104 patients suffering from closed traumatic brain injury, sampled across the United States and England.

Results: The revisions lead to qualitative (eg, precluding negative ICP) and quantitative improvements in ICP prediction. While moving from the original to the revised method, the ±2 SD of the error is reduced from 33 to 24 mm Hg, and the root-mean-squared error is reduced from 11 to 8.2 mm Hg. The distribution of root-mean-squared error is tighter as well; for the revised method the 25th and 75th percentiles are 4.1 and 13.7 mm Hg, respectively, as compared with 5.1 and 18.8 mm Hg for the original method.

Conclusions: Proposed alterations to a procedure for estimating ZFP lead to more accurate and more precise estimates of ICP, thereby offering improved means of estimating it noninvasively. The quality of the estimates is inadequate for many applications, but further work is proposed, which may lead to clinically useful results.

*Applied Physics Laboratory

Departments of Statistics

Neurological Surgery

Bioengineering, University of Washington, Seattle, WA

§Department of Neurosurgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK

Supported by the National Institutes of Health (Grant R43NS46824-01A1); National Space Biomedical Research Institute (Grant SMS00701-2009-513); and PhysioSonics Incorporated. M.K. and P.D.M. have a significant financial interest in PhysioSonics, one of the sponsors of the research described here.

The authors have no conflicts of interest to disclose.

Reprints: Caren Marzban, PhD, Applied Physics Laboratory, Department of Statistics, University of Washington, Seattle, WA 98195 (e-mail:

Received March 6, 2012

Accepted June 8, 2012

© 2013 Lippincott Williams & Wilkins, Inc.