Intracranial pressure waveform analysis: clinical and research implications.

Assessment of intracranial adaptive capacity is vital in critically ill individuals with acute brain injury because there is the potential that nursing care activities and environmental stimuli to result in clinically significant increases in intracranial pressure (ICP) in a subset of individuals with decreased intracranial adaptive capacity. ICP waveform analysis provides information about intracranial dynamics that can help identify individuals who have decreased adaptive capacity and are at risk for increases in ICP and decreases in cerebral perfusion pressure, which may contribute to secondary brain injury and have a negative impact on neurologic outcome. The ability to identify high-risk individuals allows nurses to initiate interventions targeted at decreasing adaptive demand or increasing adaptive capacity in these individuals. Changes in the ICP waveform occur under various physiologic and pathophysiologic conditions and may provide valuable information about intracranial adaptive capacity. Simple visual assessment of the ICP waveform for increased amplitude and P2 elevation is clinically relevant and has been found to provide a rough indicator of decreased adaptive capacity. Advanced ICP waveform analysis techniques warrant further study as a means of dynamically assessing intracranial adaptive capacity.