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2020-2024

Development of brain compliance monitoring methods by means of intracranial pressure pulse waveform analysis in traumatic brain injury

Project leader: prof. Magdalena Kasprowicz, PhD

OPUS 18 programme, National Science Centre, Poland, grant UMO-2019/35/B/ST7/00500

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. 10 million people are estimated to suffer from TBI every year, most of them young men below the age of 30. Methods currently used in treatment of TBI are complex, requiring interdisciplinary approaches and specialist knowledge. Therefore, studies that aim to improve our understanding of the processes occurring in the brain after injury and develop methods which allow for early warning of possible worsening of the patient’s condition and support the decision making process for early medical interventions in order to prevent secondary injury are of high socioeconomic importance.

Intracranial pressure (ICP) is routinely monitored in TBI patients in neuro-intensive care units. ICP elevation is one of the life-threatening complications of TBI as it results from increases in additional pathological volume in the intracranial space and may lead to secondary brain injury. The clinician makes decisions about treatment based on, among other parameters, the observation of the ICP value displayed on the screen of a bedside monitor. Medical interventions are usually performed too late, when the increase in ICP and adverse changes in the brain have already occurred. Therefore, sufficiently early prediction of ICP elevation may allow for preventive treatment performed prior to the occurrence of life-threatening situations. However, the measurement of ICP without knowledge about the extent to which the craniospinal space may buffer volume changes is not sufficient to fully characterize the patient’s status and introduce effective treatment. A parameter which describes the craniospinal system’s ability to compensate increases in volume is termed ‘brain compliance’. One of the methods of assessing brain compliance is based on the analysis of the shape of pulse waves of ICP which are the result of increases in cerebral blood volume naturally occurring during each heartbeat. The shape of ICP pulse waves changes with progressive exhaustion of the mechanisms compensating volume changes from a wave with three defined local maxima to a wave resembling a sinusoid. Currently, however, due to the lack of sufficiently accurate computational algorithms allowing for real-time observation of changes in the shape of ICP pulse waves and automatic classification of those shapes, this method is not used in clinical practice.

The aim of this project is to develop methods of monitoring brain compliance based on the analysis of ICP pulse wave shapes in TBI patients. We hypothesize that changes in brain compliance may precede increases in mean ICP and the analysis of ICP pulse wave shapes may be useful in the identification of patients at risk of intracranial hypertension. We plan to classify characteristic patterns of ICP pulse waves using artificial intelligence methods and analyze the changes before and during episodes of ICP elevation. The meaning of different shapes will be extensively studied during clinical conditions of known effect on brain compliance. Based on acquired knowledge we plan to build predictive models that will allow for the prediction of increases in ICP early enough to enable effective medical intervention prior to secondary brain injury. Moreover, we plan to examine the relationship between different shapes of ICP pulse waves and the patient’s clinical condition and build a model for early prediction of the patient’s outcome. The models are a significant expected result of proposed project. While analysis of ICP pulse waves does not introduce any additional risk for the patient, the invasiveness of ICP measurement is a limitation of proposed method of monitoring brain compliance. The alternative is to measure tympanic membrane displacement (TMD) which, as suggested by previous studies, is correlated with ICP increases and brain compliance. However, TMD measurement using existing commercial solution is relatively expensive and requires a special sensor introduced to the patient’s ear. Therefore, in proposed project we will also propose a new, non-contact, cheap, and most importantly non-invasive method of monitoring brain compliance based on recording TMD with a video camera and analyzing the displacements with novel methods of video processing.

Presentation of project results at the Moberg Case Studies in Neurocritical Care AI seminar (19.07.2024)

Publications:

  1. Kasprowicz, M., Mataczyński, C., Uryga, A., Pelah, A.I., Schmidt, E., Czosnyka, M., Kazimierska, A., & CENTER-TBI high-resolution sub-study participants and investigators (2025) Impact of Age and Mean Intracranial Pressure on the Morphology of Intracranial Pressure Waveform and Its Association with Mortality in Traumatic Brain Injury. Critical Care, 29 art. 78. https://doi.org/10.1186/s13054-025-05295-w
  2. Mataczyński, C., Kazimierska, A., Beqiri, E., Czosnyka, M., Smielewski, P.,  Kasprowicz, M., & CENTER-TBI high-resolution sub-study participants and investigators (2025) Interpretable Model Committee for Monitoring and Early Prediction of Intracranial Pressure Crises. Expert Systems With Applications, 265 art. 126001. https://doi.org/10.1016/j.eswa.2024.126001
  3. Smielewski, P., Beqiri, E., Mataczyński, C., Placek, M., Kazimierska, A., Hutchinson, P.J., Czosnyka, M., & Kasprowicz, M. (2024) Advanced Neuromonitoring Powered by ICM+ and Its Place in the Brand New AI World, Reflections at the 20th Anniversary Boundary. Brain and Spine (special issue The XVIII International Symposium on Intracranial Pressure and Brain Monitoring (ICP 2022)), 2024 art. 102835. https://doi.org/10.1016/j.bas.2024.102835
  4. Ziółkowski, A., Kasprowicz, M., Kazimierska, A., & Czosnyka, M. (2024) Quantitative Analysis of Similarity Between Cerebral Arterial Blood Volume and Intracranial Pressure Pulse Waveforms During Intracranial Pressure Plateau Waves. Brain and Spine (special issue The XVIII International Symposium on Intracranial Pressure and Brain Monitoring (ICP 2022)), 2024 art. 102832. https://doi.org/10.1016/j.bas.2024.102832
  5. Kazimierska, A., Uryga, A., Mataczyński, C., Czosnyka, M., Lang, E.W., Kasprowicz, M., & CENTER-TBI high-resolution sub-study participants and investigators (2023) Relationship Between the Shape of Intracranial Pressure Pulse Waveform and Computed Tomography Characteristics in Patients After Traumatic Brain Injury. Critical Care, 27 art. 447. https://doi.org/10.1186/s13054-023-04731-z
  6. Kazimierska, A., Manet, R., Vallet, A., Schmidt, E., Czosnyka, Z., Czosnyka M., & Kasprowicz, M. (2023) Analysis of Intracranial Pressure Pulse Waveform in Studies on Cerebrospinal Compliance: a Narrative Review. Physiological Measurement, 44 art. 10TR01. https://doi.org/10.1088/1361-6579/ad0020
  7. Ziółkowski, A., Kasprowicz, M., Czosnyka, M., & Czosnyka, Z. (2023) Brain Blood Flow Pulse Analysis May Help to Recognize Individuals Who Suffer from Hydrocephalus. Acta Neurochirurgica, published online. https://doi.org/10.1007/s00701-023-05839-5
  8. Uryga, A., Kazimierska, A., Popek, M., Dragan, B., Burzyńska, M., Masalski, M., & Kasprowicz, M. (2023) Applying Video Motion Magnification to Reveal Spontaneous Tympanic Membrane Displacement as an Indirect Measure of Intracranial Pressure in Patients with Brain Pathologies. Acta Neurochirurgica, 165(8), 2227-2235. https://doi.org/10.1007/s10072-022-06579-7
  9. Ziółkowski, A., Pudełko, A., Kazimierska, A., Uryga, A., Czosnyka, Z., Kasprowicz, M., & Czosnyka, M. (2023). Peak Appearance Time in Pulse Waveforms of Intracranial Pressure and Cerebral Blood Flow Velocity. Frontiers in Physiology, 13, 2670. https://doi.org/10.3389/fphys.2022.1077966
  10. Uryga, A., Ziółkowski, A., Kazimierska, A., Pudełko, A., Mataczyński, C., Lang, E. W., Czosnyka, M., Kasprowicz, M., & CENTER-TBI High-resolution Sub-study participants and investigators. (2023) Analysis of Intracranial Pressure Pulse Waveform in Traumatic Brain Injury Patients: a CENTER-TBI Study. Journal of Neurosurgery, 139(1), 201-211. https://doi.org/10.3171/2022.10.JNS221523
  11. Mataczyński, C., Kazimierska, A., Uryga, A., & Kasprowicz, M. (2022). Intracranial Pressure Pulse Morphology-based Definition of Life-threatening Intracranial Hypertension Episodes. In: 2022 44th Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC) (pp. 1742-1746). IEEE. https://doi.org/10.1109/EMBC48229.2022.9871403
  12. Mataczyński, C., Kazimierska, A., Uryga, A., Burzyńska, M., Rusiecki, A., & Kasprowicz, M. (2022). End-to-End Automatic Morphological Classification of Intracranial Pressure Pulse Waveforms Using Deep Learning. IEEE Journal of Biomedical and Health Informatics, 26(2), 494-504. https://doi.org/10.1109/JBHI.2021.3088629
  13. Kazimierska, A., Mataczyński, C., Uryga, A., Burzyńska, M., Rusiecki, A., & Kasprowicz, M. (2022). Analysis of the Relationship Between Intracranial Pressure Pulse Waveform and Outcome in Traumatic Brain Injury. In: Piaseczna, N., Gorczowska, M., Łach, A. (eds) Innovations and Developments of Technologies in Medicine, Biology and Healthcare. EMBS ISC 2020 (pp. 52-57). Springer, Cham. https://doi.org/10.1007/978-3-030-88976-0_7
  14. Ziółkowski, A., Pudełko, A., Kazimierska, A., Czosnyka, Z., Czosnyka, M., & Kasprowicz, M. (2021). Analysis of Relative Changes in Pulse Shapes of Intracranial Pressure and Cerebral Blood Flow Velocity. Physiological Measurement, 42(12), 125004. https://doi.org/10.1088/1361-6579/ac38bf
  15. Zakrzewska, A. P., Placek, M. M., Czosnyka, M., Kasprowicz, M., & Lang, E. W. (2021). Intracranial Pulse Pressure Waveform Analysis Using the Higher Harmonics Centroid. Acta Neurochirurgica, 163(12), 3249-3258. https://doi.org/10.1007/s00701-021-04958-1
  16. Kazimierska, A., Uryga, A., Mataczyński, C., Burzyńska, M., Ziółkowski, A., Rusiecki, A., & Kasprowicz, M. (2021). Analysis of the Shape of Intracranial Pressure Pulse Waveform in Traumatic Brain Injury Patients. In: 2021 43rd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC) (pp. 546-549). IEEE. https://doi.org/10.1109/EMBC46164.2021.9630516
  17. Ziółkowski, A., Kazimierska, A., Czosnyka, M., & Kasprowicz, M. (2021). Analiza zmian podatności mózgowej u pacjentów po urazie czaszkowo-mózgowym podczas umiarkowanej hipokapnii. In: Maciąg, K., Maciąg, M. (eds) Zdrowie człowieka – profilaktyka, rozpoznawanie i leczenie chorób (pp. 234-258). Wydawnictwo Naukowe TYGIEL, Lublin. [PL]

Diploma and PhD theses:

  1. Agnieszka Kazimierska, PhD thesis titled Assessment of cerebral compliance based on analysis of the shape of intracranial pressure pulse waveform, date of defense: 30.11.2022
  2. Agata Pudełko, master’s thesis titled Porównanie różnych metod analizy kształtu krzywej tętniczopochodnej ciśnienia wewnątrzczaszkowego [PL]
  3. Klaudia Kalinowska, master’s thesis titled Predykcja wyników leczenia pacjentów po urazach czaszkowo-mózgowych przy użyciu algorytmów uczenia maszynowego i biosygnałów wysokiej rozdzielczości [PL]