Journal
NEUROCRITICAL CARE
Volume 21, Issue -, Pages 64-84Publisher
HUMANA PRESS INC
DOI: 10.1007/s12028-014-0048-y
Keywords
Intracranial pressure; Cerebral perfusion pressure; Brain injury; Coma; Multimodality monitoring
Categories
Funding
- NIH
- Integra Lifesciences
- Neurologica
- Dana Foundation
- NIH, DOD
- MRC [G9439390, G1002277, G0600986, G0601025] Funding Source: UKRI
- Medical Research Council [G0600986, G0601025, G1002277, G9439390] Funding Source: researchfish
- National Institute for Health Research [NIHR-RP-R3-12-013] Funding Source: researchfish
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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.
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