Scientific Experience

Scientific Experience

My Ph.D. research at the University of Cambridge focused on modelling of brain haemodynamics, particularly describing a terminal situation of cerebral circulation, associated with ischemic strokes. A new methodology was created which can be used for estimating brain’s zero-flow pressure or critical closing pressure (CrCP): a critical threshold for arterial blood pressure (ABP). If ABP falls below CrCP, the local blood pressure inside small vessels (microcirculation) is no longer adequate to keep them open, leading them to a collapse, ceasing blood flow.

The new methodology eliminated the main drawback of previous CrCP methods, which were presenting non-physiological negative values; CrCP can now instead be considered as a reliable tool for physicians. A new CrCP-based mechanism was further introduced, which can quantify the ischemic risk for a patient during haemodynamic changes, like intracranial hypertension or arterial hypotension. In neurointensive care, this mechanism might provide a reference point to guidance of treatment in terms of terminal ischemia associated with collapsing vessels.

Based on this mechanism, the phenomenon of absence of diastolic blood flow was explained as distally collapsed small cerebral vessels, associated with ABP going below CrCP during diastole, possibly then enhancing our understanding of this phenomenon, which could lead to an imminent circulatory arrest and brain death.

Publications

1.Critical Closing Pressure During Controlled Increase in Intracranial Pressure – Comparison of Three MethodsIEEE Trans Biomed Eng. Mar 2018; 65(3):619-624.

2.Cerebral Haemodynamics during Experimental Intracranial HypertensionJ Cereb Blood Flow Metab. Feb 2017; 37(2):694-705.

3.Cerebral Critical Closing Pressure: Is the Multiparameter Model Better Suited to Estimate Physiology of Cerebral Hemodynamics? Neurocrit Care. Dec 2016; 25(3):446-454.

4.Elevated Diastolic Closing Margin Is Associated with Intraventricular Hemorrhage in Premature InfantsJ Pediatr. July 2016; 174:52-6.

5.The Diastolic Closing Margin Is Associated with Intraventricular Hemorrhage in Premature InfantsActa Neurochir Suppl. May 2016; 122:147-50.

6.The Ontogeny of Cerebrovascular Pressure Autoregulation in Premature InfantsActa Neurochir Suppl. May 2016; 122:151-5.

7.Monitoring Cerebral Autoregulation After Subarachnoid HemorrhageActa Neurochir Suppl. May 2016; 122:199-203.

8.Cerebral Critical Closing Pressure During Infusion Tests. Acta Neurochir Suppl. May 2016; 122:215-20.

9.Derangement of Cerebral Blood Flow Autoregulation During Intracranial Pressure Plateau Waves as Detected by Time and Frequency-Based MethodsActa Neurochir Suppl. May 2016; 122:233-8.

10.The Ontogeny of Cerebrovascular Critical Closing PressureActa Neurochir Suppl. May 2016; 122:249-53.

11.Measurement of Intraspinal Pressure After Spinal Cord Injury: Technical Note from the Injured Spinal Cord Pressure Evaluation StudyActa Neurochir Suppl. May 2016; 122:323-8.

12.Waveform Analysis of Intraspinal Pressure After Traumatic Spinal Cord Injury: An Observational Study (O-64)Acta Neurochir Suppl. May 2016; 122:335-8.

13.Prospective Study on Non-invasive Assessment of Intracranial Pressure in Traumatic Brain-Injured Patients: Comparison of Four MethodsJ Neurotrauma. Apr 2016; 33(8):792-802.

14.Intraspinal Pressure and Spinal Cord Perfusion Pressure after Spinal Cord Injury: an Observational StudyJ Neurosurg Spine. Aug 2015; 14:1-9.

15.Cerebral Critical Closing Pressure in Hydrocephalus Patients undertaking Infusion TestsNeurol Res. Aug 2015; 37(8):674-82.

16.Ontogeny of Cerebrovascular Critical Closing PressurePediatr Res. Jul 2015; 78(1):71-5.

17.Expansion Duroplasty improves Intraspinal Pressure, Spinal Cord Perfusion Pressure and Vascular Pressure Reactivity Index in Patients with Traumatic Spinal Cord InjuryJ Neurotrauma. Jun 2015; 32(12):865-74.

18.Comparison of Frequency and Time Domain Methods of Assessment of Cerebral Autoregulation in Traumatic Brain Injury. J Cereb Blood Flow Metab. Feb 2015; 35(2):248-56.

19.Cerebral Vasospasm affects Arterial Critical Closing PressureJ Cereb Blood Flow Metab. Feb 2015; 35(2):285-91.

20.Increased Blood Glucose is related to Disturbed Cerebrovascular Pressure Reactivity after Traumatic Brain InjuryNeurocrit Care. Feb 2015; 22(1):20-5.

21.Bilateral Failure of Cerebral Autoregulation is related to Unfavorable Outcome after Subarachnoid HemorrhageNeurocrit Care. Feb 2015; 22(1):65-73.

22.A non-invasive estimation of Cerebral Perfusion Pressure using Critical Closing PressureJ Neurosurg. Jan 2015; 9:1-11.

23.The Ontogeny of Cerebrovascular Pressure Autoregulation in Premature InfantsJ Perinatol. Dec 2014; 34(12):926-31.

24.Relationship of Vascular Wall Tension and Autoregulation following Traumatic Brain InjuryNeurocrit Care. Oct 2014; 21(2):266-74.

25.Baroreflex and Cerebral Autoregulation are Inversely CorrelatedCirc J. Sep 2014; 78(10):2460-7.

26.Repeatability of Cerebrospinal Fluid Constant Rate Infusion StudyActa Neurol Scand. Aug 2014; 130(2):131-8.

27.Pressures, Flow, and Brain Oxygenation during Plateau Waves of Intracranial PressureNeurocrit Care. Aug 2014; 21(1):124-32.

28.Monitoring of Spinal Cord Perfusion Pressure in Acute Spinal Cord Injury: Initial Findings of the Injured Spinal Cord Pressure Evaluation StudyCrit Care Med. Mar 2014; 42(3):646-55.

29.Cessation of Diastolic Cerebral Blood Flow Velocity – the role of Critical Closing PressureNeurocrit Care. Feb 2014; 20(1):40-8.

30.Model-based Indices describing Cerebrovascular DynamicsNeurocrit Care. Feb 2014; 20(1):142-57.

31.Critical Closing Pressure during Intracranial Pressure Plateau WavesNeurocrit Care. Jun 2013; 18(3):341-8.

32.Cerebral Autoregulation after Subarachnoid Haemorrhage: Comparison of Three MethodsJ Cereb Blood Flow Metab. Mar 2013; 33(3):449-56.

33.Critical Closing Pressure determined with a Model of Cerebrovascular ImpedanceJ Cereb Blood Flow Metab. Feb 2013; 33(2):235-43.

34.Multi-Modal Monitoring for Brain Injury in Critically Ill Children. Pediatric Critical Care Medicine. May 2014; 15(Issue 4_suppl): 68, Abstract 290 – Abstracts of the 7th World Congress on Pediatric Critical Care

35.Measurement and Optimisation of Spinal Cord Perfusion Pressure in Acute Spinal Cord InjuryBritish Journal of Neurosurgery. Oct 2013: 27(5):556, Abstract WM1-2 – Proceedings of the 2013 Autumn meeting of the Society of British Neurological Surgeons

36.Improving the Physiological Interpretation of Cerebral Critical Closing PressureCerebrovascular Diseases. May 2013; 35, Abstract O7 – 18th Meeting of the European Society of Neurosonology and Cerebral Hemodynamics and 3rd Meeting of the Cerebral Autoregulation Network

Citations

Citations of my research can be found at: