Abstract
Sixty years have passed since neurosurgeon Nils Lundberg presented his thesis about intracranial pressure (ICP) monitoring, which represents a milestone for its clinical introduction. Monitoring of ICP has since become a clinical routine worldwide, and today represents a cornerstone in surveillance of patients with acute brain injury or disease, and a diagnostic of individuals with chronic neurological disease. There is, however, controversy regarding indications, clinical usefulness and the clinical role of the various ICP scores. In this paper, we critically review limitations and weaknesses with the current ICP measurement approaches for invasive, less invasive and non-invasive ICP monitoring. While risk related to the invasiveness of ICP monitoring is extensively covered in the literature, we highlight other limitations in current ICP measurement technologies, including limited ICP source signal quality control, shifts and drifts in zero pressure reference level, affecting mean ICP scores and mean ICP-derived indices. Control of the quality of the ICP source signal is particularly important for non-invasive and less invasive ICP measurements. We conclude that we need more focus on mitigation of the current limitations of today’s ICP modalities if we are to improve the clinical utility of ICP monitoring.
Highlights
Sixty years have passed since neurosurgeon Nils Lundberg presented his thesis about intracranial pressure (ICP) monitoring, which represents a milestone for its clinical introduction
The cerebral perfusion pressure (CPP) is the parameter most extensively applied for this purpose, which refers to the difference between mean arterial blood pressure (BP) and mean ICP
Invasive ICP source signals from implantable pressure sensors Given that the comprehensive research on non-invasive ICP monitoring has not yet provided any technique that can be readily adopted in clinical practice, it is possible that current research should be shifted to smaller and more achievable goals
Summary
There are numerous challenges related to more permanent implantable pressure sensors that the field has yet to overcome. Health care personnel need to be offered better means for assessing the ICP source signal. Best practice would require implementation of algorithms for automatic assessment of the ICP source signal in systems used for ICP measurements. Implementation of pulsatile ICP measurements as clinical routine The current ICP monitoring practice of only measuring static ICP (mean ICP), not pulsatile ICP, implies that only parts of the information within the ICP signal are provided to the health care personnel. Assessment of pulsatile ICP requires a routine for single ICP wave identification Such algorithms are currently not included in ICP measurement devices. Shift of attention from non‐invasive technologies towards implantable ICP sensors With regard to non-invasive ICP monitoring, there are currently no clinically useful source signals available for continuous ICP estimates. We believe development of implantable miniature ICP sensors has a far greater potential than searching for means to measure nICP
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