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Concept
Intracranial pressure monitoring
Summary
The monitoring of intracranial pressure (ICP) is used in the treatment of a number of neurological conditions ranging from severe traumatic brain injury to stroke and brain bleeds. This process is called intracranial pressure monitoring. Monitoring is important as persistent increases in ICP is associated with worse prognosis in brain injuries due to decreased oxygen delivery to the injured area and risk of brain herniation.
ICP monitoring is usually used on patients who have decreased score on the Glasgow Coma Scale, indicating poor neurologic function. It is also used in patients who have non-reassuring imaging on CT, indicating compression of normal structures from swelling.
Most current clinically available measurement methods are invasive, requiring surgery to place the monitor in the brain itself. Of these, external ventricular drainage (EVD) is the current gold standard as it allows physicians to both monitor ICP and treat if necessary. Some non-invasive intracranial pressure measurement methods are currently being studied, however none are currently able to deliver the same accuracy and reliability of invasive methods.
Intracranial pressure monitoring is just one tool to manage ICP. It is used in conjunction with other techniques such as ventilator settings to manage levels of carbon dioxide in the blood, head and neck position, and other therapies such as hyperosmolar therapy, medications, and core temperature. However, there is no current consensus on the clinical benefit of ICP monitoring in overall ICP management, with evidence both supporting its use and finding no benefit in reducing mortality.
Injury to the brain will often result in brain swelling. As the brain is encased in the skull, limited swelling can be accommodated until the brain is no longer able to maintain normal function. There are two potential negative consequences from this swelling: ischemia due to compression of the brain tissue resulting in lack of blood and oxygen, and herniation of the brain.
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