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Management of Elevated Intracranial Pressure: a Review

  • Critical Care (Stephan A. Mayer, Section Editor)
  • Published:
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Abstract

Purpose of Review

Principles of intracranial pressure (ICP) management continue to be an essential part of the neurointensivist’s skillset as appropriate treatment decisions can prevent secondary injury to the central nervous system. This review of the literature aims to: discuss commonly encountered pathologies associated with increased ICP, summarize diagnostic approaches used in evaluating ICP, and present evidence-based treatment paradigms that drive clinical care in intensive care units.

Recent Findings

Recent topics of discussion include invasive and non-invasive modalities of diagnosis and monitoring, recent developments in hypothermia, hyperosmolar therapy, pharmacological interventions, and surgical therapies. The authors also present an example of an algorithm used within our system of hospitals for managing patients with elevated ICP.

Summary

Recent advances have shown the mortality benefits in appropriately recognizing and treating increased ICP. Multiple modalities of treatment have been explored, and evidence has shown benefit in some. Further work continues to provide clarity in the appropriate management of intracranial hypertension.

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Abbreviations

ICP:

intracranial pressure

EVD:

external ventricular drain

IPM:

intraparenchymal monitors

TBI:

traumatic brain injury

BEST:TRIP:

Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure

CSF:

cerebrospinal fluid

US:

ultrasound, ultrasonography

ONSD-:

optic nerve sheath diameter

AUC:

area under the curve

ETD:

eyeball transverse diameter

TCD:

transcranial Doppler

CPP:

cerebral perfusion pressure

ICU:

Intensive care unit

NPi:

neurological pupil index

cEEG:

continuous electroencephalography

CBF:

cerebral blood flow

CSD:

cortical spreading depression

HOT:

hyperosmolar therapy

ICH:

intracranial hemorrhage

HTS:

hypertonic saline

IV:

intravenous

GAMES-RP:

glyburide advantage in malignant edema and stroke

MRC-CRASH:

Corticosteroids Randomisation after Significant Head injury

NABISH:

National Acute Brain Injury Study: Hypothermia

POLAR:

Prophylactic Hypothermia Trial to Lessen Traumatic Brain Injury

TTM:

therapeutic temperature modulation

GOS-E:

extended Glasgow outcome scale

RESCUEicp:

Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of ICP

DECRA:

Decompressive Craniectomy trial

CLEAR-III:

Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage Phase-III

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Neurology, NYU Langone, 222 East 41st Street, 9th Floor, New York, NY, 10017, USA

    Abhinav R. Changa, Barry M. Czeisler & Aaron S. Lord

  2. Division of Neurocritical Care, NYU Langone, 530 First Avenue, HCC Suite 5A, New York, NY, 10016, USA

    Barry M. Czeisler & Aaron S. Lord

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  1. Abhinav R. Changa
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Abhinav R. Changa, Barry M. Czeisler, and Aaron Sylvan Lord each declare no potential conflicts of interest.

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Changa, A.R., Czeisler, B.M. & Lord, A.S. Management of Elevated Intracranial Pressure: a Review. Curr Neurol Neurosci Rep 19, 99 (2019). https://doi.org/10.1007/s11910-019-1010-3

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