The Course of Intracranial Pressure in Traumatic Brain Injury: Relation with Outcome and CT-characteristics

Abstract

During ICP monitoring different ICP profiles are present over time. These profiles are related to CT-characteristics and outcome. The importance of early and late monitoring of ICP is underlined.

Early Head Computed Tomography Abnormalities Associated with Elevated Intracranial Pressure in Severe Traumatic Brain Injury

“…The incidence of clinically relevant ICP elevation was similar to that described in prior studies 16,22 . The inverse correlation of ICP with age has been described before and may be accounted for by lower parenchymal volume in older patients 36 .…”

“…Few tools exist to detect evolution of primary brain injury, to identify patients at early risk of secondary brain injury from elevated intracranial pressure (ICP), and to direct early clinical decisions about therapeutic interventions. Previously described radiologic scales, including the Marshall Scale and the Rotterdam Scale, associate early radiographic findings with mortality, but are inconsistently correlated with elevated ICP 13–17 . Additionally, many patients with a sTBI who have a normal or only mildly abnormal head CT on admission will still go on to develop elevated ICP 18,19 .…”

“…Invasive devices are commonly used to monitor ICP after sTBI. Elevated ICP (defined as ≥20‐22 mm Hg) occurs in 40‐70% of patients with sTBI and is associated with increased morbidity and mortality 16,20–23 . ICP monitoring has been correlated with lower in‐hospital and 2‐week mortality in observational studies, 21,22,24–26 although monitoring failed to improve outcomes in resource‐limited settings in a randomized controlled trial 27 .…”

Factors influencing intracranial pressure monitoring guideline compliance and outcome after severe traumatic brain injury*

“…Also in patients with a TCDB II classification, compliance was relatively low (33%). Yet, in a recent series of ICP-monitored patients, 50% with a TCDB II classification developed raised ICP (45). The noncompliance in patients without or with minor visible pathology suggests that clinicians are often not convinced that ICP monitoring in this subgroup of severe TBI patients is necessary; therefore, the extent of CT abnormalities that require ICP monitoring deserves further investigation.…”

Effects of Positive End Expiratory Pressure (PEEP) on Intracranial and Cerebral Perfusion Pressure In Pediatric Neurosurgical Patients

“…ICP monitoring and control are central to the management of major acute neurosurgical conditions, because elevated ICP is common after major acute neurosurgical conditions. 13 The anesthetic management of all patients followed our institutional protocol, 14,15 including ICP monitoring for 48 hours after surgery. Inclusion criteria were: age between 2 and 14 years, cerebral disease requiring neurosurgery with an indication for postoperative monitoring of ICP after brain tumor removal through an intraventricular catheter, and the need for postoperative mechanical ventilation.…”