Intracranial Pressure Monitoring: Fundamental Considerations and Rationale for Monitoring

The Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring

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59 Scopus citations

Abstract

Traumatic brain injury (TBI) is a major cause of death and disability worldwide. In large part critical care for TBI is focused on the identification and management of secondary brain injury. This requires effective neuromonitoring that traditionally has centered on intracranial pressure (ICP). The purpose of this paper is to review the fundamental literature relative to the clinical application of ICP monitoring in TBI critical care and to provide recommendations on how the technique maybe applied to help patient management and enhance outcome. A PubMed search between 1980 and September 2013 identified 2,253 articles; 244 of which were reviewed in detail to prepare this report and the evidentiary tables. Several important concepts emerge from this review. ICP monitoring is safe and is best performed using a parenchymal monitor or ventricular catheter. While the indications for ICP monitoring are well established, there remains great variability in its use. Increased ICP, particularly the pattern of the increase and ICP refractory to treatment is associated with increased mortality. Class I evidence is lacking on how monitoring and management of ICP influences outcome. However, a large body of observational data suggests that ICP management has the potential to influence outcome, particularly when care is targeted and individualized and supplemented with data from other monitors including the clinical examination and imaging.

Original languageEnglish (US)
Pages (from-to)64-84
Number of pages21
JournalNeurocritical Care
Volume21
Issue number2
DOIs
StatePublished - Oct 1 2014

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Keywords

  • Brain injury
  • Cerebral perfusion pressure
  • Coma
  • Intracranial pressure
  • Multimodality monitoring

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

The Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring (2014). Intracranial Pressure Monitoring: Fundamental Considerations and Rationale for Monitoring. Neurocritical Care, 21(2), 64-84. https://doi.org/10.1007/s12028-014-0048-y