Intensive Care Medicine

, Volume 33, Issue 7, pp 1263–1271 | Cite as

Neuromonitoring in the intensive care unit. I. Intracranial pressure and cerebral blood flow monitoring

Review

Abstract

Background

Monitoring the injured brain is an integral part of the management of severely brain injured patients in intensive care. Brain-specific monitoring techniques enable focused assessment of secondary insults to the brain and may help the intensivist in making appropriate interventions guided by the various monitoring techniques, thereby reducing secondary brain damage following acute brain injury.

Discussion

This review explores methods of monitoring the injured brain in an intensive care unit, including measurement of intracranial pressure and analysis of its waveform, and techniques of cerebral blood flow assessment, including transcranial Doppler ultrasonography, laser Doppler and thermal diffusion flowmetry.

Conclusions

Various modalities are available to monitor the intracranial pressure and assess cerebral blood flow in the injured brain in intensive care unit. Knowledge of advantages and limitations of the different techniques can improve outcome of patients with acute brain injury.

Keywords

Traumatic brain injury Intracranial pressure Ultrasonography, Doppler, transcranial Flowmetry, laser Doppler Thermal diffusion flowmetry 

Abbreviations

ABP

arterial blood pressure

AMP

amplitude of fundamental component of ICP waveform

CBF

cerebral blood flow

CBV

cerebral blood volume

CO2

carbon dioxide

CPP

cerebral perfusion pressure

CSF

cerebrospinal fluid

CT

computerised tomography

DID

delayed ischaemic neurological deficit

EDP

effective downstream pressure

FV

flow velocity

HDI

haemodynamic impairment

ICP

intracranial pressure

ICU

intensive care unit

LDF

laser Doppler flowmetry

MAP

mean arterial pressure

MCA

middle cerebral artery

MRI

magnetic resonance imaging

nCPP

non-invasively determined cerebral perfusion pressure

nICP

non-invasive ICP measurement

PET

positron emission tomography

PI

pulsatility index

PRx

pressure reactivity index

RI

resistance index

RAP

correlation of amplitude and pressure of ICP waveform

SAH

subarachnoid haemorrhage

TBI

traumatic brain injury

TCD

transcranial Doppler

TD

thermal diffusion

THRT

transient hyperaemic response test

US

ultrasound

ZFP

zero flow pressure

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Department of AnaesthesiaAddenbrooke’s HospitalCambridgeUK
  2. 2.Neuroscience Critical Care UnitAddenbrooke’s HospitalCambridgeUK

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