Intracranial Pressure Monitoring in Severe Traumatic Brain Injury – Results of a Canadian Survey

Abstract

ABSTRACT:Objective:The purpose of this study was to obtain information from Canadian neurosurgeons regarding their opinions on, and utilization of, intracranial pressure (ICP) monitoring for severe traumatic brain injury (TBI).Methods:A brief survey was sent to practicing Canadian neurosurgeons questioning them about their utilization of, and confidence in, intracranial pressure monitoring in the management of patients with severe TBI.Results:One hundred and ninety-six surveys were mailed. There were 103 responses for a response rate of 52.6%. The vast majority of responding neurosurgeons (98.1%) utilized ICP monitoring in the management of patients with severe TBI, with most (63.4%) using it in more than 75% of their patients, 14.9% using it in 50-75% of patients, 14.9% in 25-50% of patients, and 6.9% using it in less than 25% of patients. The level of confidence that routine monitoring improves outcome from severe TBI ranged from 23.3% having a low level of confidence, 56.3% having an intermediate level of confidence, to 20.4% having a high level of confidence. Most respondents (78.6%) felt that some form of prospective trial evaluating the role of ICP monitoring in improving outcome from severe TBI was warranted; 17.4% felt such a trial was not warranted and 3.9% were uncertain.Conclusions:While ICP monitoring has gained almost universal acceptance among responding Canadian neurosurgeons, their level of confidence that routine monitoring improves outcome from severe TBI was quite variable, with only 20.4% of respondents having a high level of confidence. Over 75% of respondents felt that some form of prospective trial evaluating the utility of ICP monitoring is warranted. This information is being used in consideration of a prospective trial addressing this issue.

Does ICP monitoring make a difference in neurocritical care?

“…Surveys of critical care management indicate that ICP monitors are currently used in approximately 75% of specialist neurosurgical centres in developed countries [10][11][12] and in 9-28% of non-specialist hospitals caring for head-injured patients [13,14]. The gold standard for assessing ICP is a catheter inserted into one of the lateral ventricles and connected to an external pressure transducer zeroed at the foramen of Monro (or, for clinical purposes, the ear).…”

“…More commonly, however, an intraparenchymal probe will be used with a miniature strain gauge pressure sensor mounted at its tip. Despite the widespread use of ICP monitors, many clinicians seriously doubt whether routine monitoring improves outcome after severe traumatic brain injury and feel that a trial addressing this issue is warranted [11].…”

“…Nonetheless, given the fact that aggressive ICP-guided care may be associated with increased lengths of stay, conceivable costs and possible adverse events, whereas outcome benefits are doubtful, I think a trial is still in demand. This view was shared by a majority of Canadian neurosurgeons in 2000 [11]. However, such a trial would pose several complicated design issues.…”

Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury*

“…Surveys of critical care management in Europe and North America indicate that ICP is monitored routinely in approximately 75% of centers that provide care for severely head-injured patients (7,8). Nonetheless, a randomized trial addressing the efficacy of ICP-guided therapy is still in demand, although-at the same time-many clinicians are reluctant to randomize their patients because they believe that monitoring has become central to appropriate management (8).…”

“…Nonetheless, a randomized trial addressing the efficacy of ICP-guided therapy is still in demand, although-at the same time-many clinicians are reluctant to randomize their patients because they believe that monitoring has become central to appropriate management (8). Infections and bleeding complications resulting from the use of ICP monitoring devices are rare (6,9).…”