Monitoring and Managing Raised Intracranial Pressure after Traumatic Brain Injury

Abstract

The primary aim of the intensive care management of traumatic brain injury (TBI) is to prevent and treat secondary brain injury using a multi-faceted neuroprotective strategy to maintain cerebral perfusion in order to meet the brain’s metabolic demands. Raised intracranial pressure (ICP) is an important cause of secondary brain injury and associated with adverse outcome after TBI. It can be related to intracranial mass lesions, contusional injuries, vascular engorgement, and brain edema. The prevention and control of raised ICP, and maintenance of cerebral perfusion pressure (CPP), are fundamental therapeutic goals after TBI. Despite the absence of class-1 studies, ICP monitoring has developed a prominent role in the management of severe TBI and is recommended by international consensus guidance. It is generally accepted as a relatively low-risk, high-yield, and value for money intervention, although there are wide variations in its application.