Real-world appraisal of intracranial pressure monitoring

Abstract

The management of elevated intracranial pressure (ICP) is an essential component of modern neurocritical care for acute brain injury. Direct and continuous monitoring of ICP has generally been considered the most reliable evaluation of ICP and is an important aspect of care for patients with severe brain injury. ICP monitoring is recommended in the Brain Trauma Foundation guidelines and its use is well established in managing severe traumatic brain injury (TBI). 1 Kolias AG Rubiano AM Figaji A Servadei F Hutchinson PJ Traumatic brain injury: global collaboration for a global challenge. Lancet Neurol. 2019; 18: 136-137 Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar The deterioration of patients with intracerebral haemorrhage 2 Cordonnier C Demchuk A Ziai W Anderson CS Intracerebral haemorrhage: current approaches to acute management. Lancet. 2018; 392: 1257-1268 Summary Full Text Full Text PDF PubMed Scopus (177) Google Scholar or subarachnoid haemorrhage 3 Macdonald RL Delayed neurological deterioration after subarachnoid haemorrhage. Nat Rev Neurol. 2014; 10: 44-58 Crossref PubMed Scopus (428) Google Scholar might also be associated with increased ICP, indicating the importance of ICP monitoring in these patients. Intracranial pressure monitoring in patients with acute brain injury in the intensive care unit (SYNAPSE-ICU): an international, prospective observational cohort studyThe use of ICP monitoring and ICP management varies greatly across centres and countries. The use of ICP monitoring might be associated with a more intensive therapeutic approach and with lower 6-month mortality in more severe cases. Intracranial hypertension treatment guided by monitoring might be considered in severe cases due to the potential associated improvement in long-term clinical results. Full-Text PDF Intracranial pressure monitoring and unfavourable outcomesI read with interest the Article by Chiara Robba and colleagues,1 who reported the findings of the SYNAPSE-ICU observational study of intracranial pressure (ICP) monitoring in patients with acute brain injury. The BEST TRIP trial2 has been the only randomised controlled trial of ICP monitoring to date, and it showed no benefit of this approach in patients with traumatic brain injury. The BEST TRIP trial, however, appears to be the primary foil for SYNAPSE-ICU. These two studies asked different research questions. Full-Text PDF Intracranial pressure monitoring and unfavourable outcomes – Authors' replyWe thank Randall Chesnut and Leonardo Welling and colleagues for their comments on our Article on the SYNAPSE-ICU observational study.1 Chesnut compared the objectives and outcomes of the study with those of the BEST TRIP randomised trial.2 We agree that the aims of SYNAPSE-ICU were fundamentally different to those of BEST TRIP. In SYNAPSE-ICU, we described practice variation and assessed the effect of intracranial pressure (ICP) monitoring on long-term outcomes. A general question discussed daily in intensive care units is about whether to insert an ICP monitoring device after severe acute brain damage. Full-Text PDF Intracranial pressure monitoring and unfavourable outcomesFor prediction of brain injury, intracranial pressure (ICP) monitoring is deemed essential by evidence-based guidelines.1 However, in resource-poor countries, ICP monitoring can be considered a luxury. For many patients in these regions, the management of intracranial hypertension in acute neurological situations is based on radiological assessment.1 However, findings on imaging do not correlate directly with the occurrence of intracranial hypertension.1,2 Full-Text PDF