Skip to main content

Advertisement

Log in

Intracranial pressure: current perspectives on physiology and monitoring

  • Review
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

A Correction to this article was published on 03 February 2023

A Correspondence to this article was published on 23 January 2023

This article has been updated

Abstract

Intracranial pressure (ICP) monitoring is now viewed as integral to the clinical care of many life-threatening brain insults, such as severe traumatic brain injury, subarachnoid hemorrhage, and malignant stroke. It serves to warn of expanding intracranial mass lesions, to prevent or treat herniation events as well as pressure elevation which impedes nutrient delivery to the brain. It facilitates the calculation of cerebral perfusion pressure (CPP) and the estimation of cerebrovascular autoregulatory status. Despite advancements in our knowledge emanating from a half century of experience with this technology, important controversies remain related even to fundamental aspects of ICP measurements, including indications for monitoring, ICP treatment thresholds, and management of intracranial hypertension. Here, we review the history of ICP monitoring, the underlying pathophysiology as well as current perspectives on why, when and how ICP monitoring is best used. ICP is typically assessed invasively but a number of emerging, non-invasive technologies with inherently lower risk are showing promise. In selected cases, additional neuromonitoring can be used to assist in the interpretation of ICP monitoring information and adapt directed treatment accordingly. Additional efforts to expand the evidence base relevant to ICP monitoring, related technologies and management remain a high priority in neurosurgery and neurocritical care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Adapted from Tadevosyan & Kornbluth, 2021 [70]

Fig. 3

Adapted from Budohoski et al., 2013 [71]

Fig. 4

Adapted from Rosner et al., 1995 [54]

Similar content being viewed by others

Change history

Abbreviations

AUC:

Area under the curve

BEST TRIP:

Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure

BTF:

Brain Trauma Foundation

CPP:

Cerebral perfusion pressure

CSF:

Cerebrospinal fluid

DC:

Decompressive craniectomy

EVD:

External ventricular drain

gPI:

Gosling Pulsatility Index

ICH:

Intracerebral hemorrhage

ICP:

Intracranial pressure

ICU:

Intensive care unit

MAP:

Mean arterial blood pressure

MOR:

Median odds ratio

nICP:

Non-invasively measured ICP

NPi:

Neurological pupillary index

ONS:

Optic nerve sheath

ONSD:

Optic nerve sheath diameter

PRx:

Pressure reactivity index

SAH:

Subarachnoid hemorrhage

SIBICC:

Seattle International severe traumatic Brain Injury Consensus Conference

TBI:

Traumatic brain injury

References

  1. Monro A (1783) Observations on the structure and functions of the nervous system. Illustrated with tables. William Creech, Edinburgh

  2. Quincke HI (1891) Verhandlungen des Congresses für Innere Medizin. Wiesbaden 10:321–331

    Google Scholar 

  3. Guillaume J, Janny P (1951) Continuous intracranial manometry; importance of the method and first results. Rev Neurol (Paris) 84:131–142

    CAS  Google Scholar 

  4. Cronqvist S, Lundberg N (1968) Regional cerebral blood flow in intracranial tumours with special regard to cases with intracranial hypertension. Scand J Clin Lab Invest Suppl 102:XV:A

    CAS  Google Scholar 

  5. Kjallquist A, Lundberg N, Ponten U (1964) Respiratory and cardiovascular changes during rapid spontaneous variations of ventricular fluid pressure in patients with intracranial hypertension. Acta Neurol Scand 40:291–317

    Article  CAS  Google Scholar 

  6. Lundberg N (1960) Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand Suppl 36:1–193

    CAS  Google Scholar 

  7. Lundberg N (1972) Monitoring of intracranial pressure. Proc R Soc Med 65:19–22

    CAS  Google Scholar 

  8. Lundberg N, Cronqvist S, Kjallquist A (1968) Clinical investigations on interrelations between intracranial pressure and intracranial hemodynamics. Prog Brain Res 30:69–75

    Article  CAS  Google Scholar 

  9. Lundberg N, Troupp H, Lorin H (1965) Continuous recording of the ventricular-fluid pressure in patients with severe acute traumatic brain injury. A preliminary report. J Neurosurg 22:581–590

    Article  CAS  Google Scholar 

  10. Risberg J, Lundberg N, Ingvar DH (1969) Regional cerebral blood volume during acute transient rises of the intracranial pressure (plateau waves). J Neurosurg 31:303–310

    Article  CAS  Google Scholar 

  11. Wijdicks EFM (2019) Lundberg and his Waves. Neurocrit Care 31:546–549

    Article  Google Scholar 

  12. Germon K (1988) Interpretation of ICP pulse waves to determine intracerebral compliance. J Neurosci Nurs 20:344–351

    Article  CAS  Google Scholar 

  13. Miller JD, Becker DP, Ward JD, Sullivan HG, Adams WE, Rosner MJ (1977) Significance of intracranial hypertension in severe head injury. J Neurosurg 47:503–516

    Article  CAS  Google Scholar 

  14. Hawryluk GWJ, Nielson JL, Huie JR, Zimmermann L, Saigal R, Ding Q, Hirschi R, Zeiler FA, Ferguson AR, Manley GT (2020) Analysis of normal high-frequency intracranial pressure values and treatment threshold in neurocritical care patients: insights into normal values and a potential treatment threshold. JAMA Neurol 77:1150–1158

    Article  Google Scholar 

  15. Bullock R, Chesnut RM, Clifton G, Ghajar J, Marion DW, Narayan RK, Newell DW, Pitts LH, Rosner MJ, Wilberger JW (1996) Guidelines for the management of severe head injury. Brain Trauma Foundation. Eur J Emerg Med 3:109–127

    Article  CAS  Google Scholar 

  16. The Brain Trauma Foundation (2000) The American Association of Neurological Surgeons. The joint section on neurotrauma and critical care. Methodol J Neurotrauma 17:561–562

  17. Brain Trauma F, American Association of Neurological S, Congress of Neurological S, Joint Section on N, Critical Care AC, Carney NA (2007) Guidelines for the management of severe traumatic brain injury. Methods J Neurotrauma 24(Suppl 1):S3–6

  18. Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J (2017) Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery 80:6–15

  19. Talving P, Karamanos E, Teixeira PG, Skiada D, Lam L, Belzberg H, Inaba K, Demetriades D (2013) Intracranial pressure monitoring in severe head injury: compliance with Brain Trauma Foundation guidelines and effect on outcomes: a prospective study. J Neurosurg 119:1248–1254

    Article  Google Scholar 

  20. Gerber LM, Chiu YL, Carney N, Hartl R, Ghajar J (2013) Marked reduction in mortality in patients with severe traumatic brain injury. J Neurosurg 119:1583–1590

    Article  Google Scholar 

  21. Hawryluk GWJ, Ghajar J (2021) Evolution and impact of the brain trauma foundation guidelines. Neurosurgery 89:1148–1156

    Article  Google Scholar 

  22. Marmarou A, Anderson RL, Ward JD, Choi SC, Young HF (1991) Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 75:s59–s66

    Article  Google Scholar 

  23. Stocchetti N, Zanaboni C, Colombo A, Citerio G, Beretta L, Ghisoni L, Zanier ER, Canavesi K (2008) Refractory intracranial hypertension and “second-tier” therapies in traumatic brain injury. Intensive Care Med 34:461–467

    Article  Google Scholar 

  24. Vik A, Nag T, Fredriksli OA, Skandsen T, Moen KG, Schirmer-Mikalsen K, Manley GT (2008) Relationship of “dose” of intracranial hypertension to outcome in severe traumatic brain injury. J Neurosurg 109:678–684

    Article  Google Scholar 

  25. Guiza F, Depreitere B, Piper I, Citerio G, Chambers I, Jones PA, Lo TY, Enblad P, Nillson P, Feyen B, Jorens P, Maas A, Schuhmann MU, Donald R, Moss L, Van den Berghe G, Meyfroidt G (2015) Visualizing the pressure and time burden of intracranial hypertension in adult and paediatric traumatic brain injury. Intensive Care Med 41:1067–1076

    Article  Google Scholar 

  26. Badri S, Chen J, Barber J, Temkin NR, Dikmen SS, Chesnut RM, Deem S, Yanez ND, Treggiari MM (2012) Mortality and long-term functional outcome associated with intracranial pressure after traumatic brain injury. Intensive Care Med 38:1800–1809

    Article  Google Scholar 

  27. Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D'Urso P, Kossmann T, Ponsford J, Seppelt I, Reilly P, Wolfe R, Investigators DT, Australian, New Zealand Intensive Care Society Clinical Trials G (2011) Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 364:1493–1502

  28. Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, Anderson I, Bulters DO, Belli A, Eynon CA, Wadley J, Mendelow AD, Mitchell PM, Wilson MH, Critchley G, Sahuquillo J, Unterberg A, Servadei F, Teasdale GM, Pickard JD, Menon DK, Murray GD, Kirkpatrick PJ, Collaborators RET (2016) Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med 375:1119–1130

    Article  Google Scholar 

  29. Magni F, Pozzi M, Rota M, Vargiolu A, Citerio G (2015) High-resolution intracranial pressure burden and outcome in subarachnoid hemorrhage. Stroke 46:2464–2469

    Article  Google Scholar 

  30. Carra G, Elli F, Ianosi B, Flechet M, Huber L, Rass V, Depreitere B, Guiza F, Meyfroidt G, Citerio G, Helbok R (2021) Association of dose of intracranial hypertension with outcome in subarachnoid hemorrhage. Neurocrit Care 34:722–730

    Article  Google Scholar 

  31. Narayan RK, Kishore PR, Becker DP, Ward JD, Enas GG, Greenberg RP, Domingues Da Silva A, Lipper MH, Choi SC, Mayhall CG, Lutz HA 3rd, Young HF (1982) Intracranial pressure: to monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg 56:650–659

    Article  CAS  Google Scholar 

  32. Le Roux P, Menon DK, Citerio G, Vespa P, Bader MK, Brophy G, Diringer MN, Stocchetti N, Videtta W, Armonda R, Badjatia N, Bosel J, Chesnut R, Chou S, Claassen J, Czosnyka M, De Georgia M, Figaji A, Fugate J, Helbok R, Horowitz D, Hutchinson P, Kumar M, McNett M, Miller C, Naidech A, Oddo M, Olson D, O'Phelan K, Provencio JJ, Puppo C, Riker R, Roberson C, Schmidt M, Taccone F (2014) The International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: a list of recommendations and additional conclusions: a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine. Neurocrit Care 21(Suppl 2):S282–296

  33. Huijben JA, Wiegers EJA, Lingsma HF, Citerio G, Maas AIR, Menon DK, Ercole A, Nelson D, van der Jagt M, Steyerberg EW, Helbok R, Lecky F, Peul W, Birg T, Zoerle T, Carbonara M, Stocchetti N (2020) Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis. Intensive Care Med 46:995–1004

  34. Alali AS, Temkin N, Barber J, Pridgeon J, Chaddock K, Dikmen S, Hendrickson P, Videtta W, Lujan S, Petroni G, Guadagnoli N, Urbina Z, Chesnut RM (2018) A clinical decision rule to predict intracranial hypertension in severe traumatic brain injury. J Neurosurg 131:612–619

    Article  Google Scholar 

  35. Connolly ES, Jr., Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P, American Heart Association Stroke C, Council on Cardiovascular R, Intervention, Council on Cardiovascular N, Council on Cardiovascular S, Anesthesia, Council on Clinical C (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke 43:1711–1737

  36. Hemphill JC, 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D, American Heart Association Stroke C, Council on C, Stroke N, Council on Clinical C (2015) Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 46:2032–2060

  37. Citerio G, Robba C, Graziano F, Rebora P (2021) Intracranial pressure monitoring and unfavourable outcomes—authors’ reply. Lancet Neurol 20:979

    Article  Google Scholar 

  38. Brain Trauma F, American Association of Neurological S, Congress of Neurological S, Joint Section on N, Critical Care AC, Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, Manley GT, Nemecek A, Newell DW, Rosenthal G, Schouten J, Shutter L, Timmons SD, Ullman JS, Videtta W, Wilberger JE, Wright DW (2007) Guidelines for the management of severe traumatic brain injury. VII. Intracranial pressure monitoring technology. J Neurotrauma 24(Suppl 1):S45–54

  39. Bauer DF, Razdan SN, Bartolucci AA, Markert JM (2011) Meta-analysis of hemorrhagic complications from ventriculostomy placement by neurosurgeons. Neurosurgery 69:255–260

    Article  Google Scholar 

  40. Raboel PH, Bartek J Jr, Andresen M, Bellander BM, Romner B (2012) Intracranial pressure monitoring: invasive versus non-invasive methods-a review. Crit Care Res Pract 2012:950393

    CAS  Google Scholar 

  41. Robba C, Bacigaluppi S, Cardim D, Donnelly J, Bertuccio A, Czosnyka M (2016) Non-invasive assessment of intracranial pressure. Acta Neurol Scand 134:4–21

    Article  CAS  Google Scholar 

  42. Robba C, Santori G, Czosnyka M, Corradi F, Bragazzi N, Padayachy L, Taccone FS, Citerio G (2018) Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis. Intensive Care Med 44:1284–1294

    Article  Google Scholar 

  43. Robba C, Cardim D, Tajsic T, Pietersen J, Bulman M, Donnelly J, Lavinio A, Gupta A, Menon DK, Hutchinson PJA, Czosnyka M (2017) Ultrasound non-invasive measurement of intracranial pressure in neurointensive care: a prospective observational study. PLoS Med 14:e1002356

    Article  Google Scholar 

  44. Czosnyka M, Richards HK, Whitehouse HE, Pickard JD (1996) Relationship between transcranial Doppler-determined pulsatility index and cerebrovascular resistance: an experimental study. J Neurosurg 84:79–84

    Article  CAS  Google Scholar 

  45. de Riva N, Budohoski KP, Smielewski P, Kasprowicz M, Zweifel C, Steiner LA, Reinhard M, Fabregas N, Pickard JD, Czosnyka M (2012) Transcranial Doppler pulsatility index: what it is and what it isn’t. Neurocrit Care 17:58–66

    Article  Google Scholar 

  46. Rasulo FA, Bertuetti R, Robba C, Lusenti F, Cantoni A, Bernini M, Girardini A, Calza S, Piva S, Fagoni N, Latronico N (2017) The accuracy of transcranial Doppler in excluding intracranial hypertension following acute brain injury: a multicenter prospective pilot study. Crit Care 21:44

    Article  Google Scholar 

  47. Rasulo FA, Calza S, Robba C, Taccone FS, Biasucci DG, Badenes R, Piva S, Savo D, Citerio G, Dibu JR, Curto F, Merciadri M, Gritti P, Fassini P, Park S, Lamperti M, Bouzat P, Malacarne P, Chieregato A, Bertuetti R, Aspide R, Cantoni A, McCredie V, Guadrini L, Latronico N (2022) Transcranial Doppler as a screening test to exclude intracranial hypertension in brain-injured patients: the IMPRESSIT-2 prospective multicenter international study. Crit Care 26:110

    Article  Google Scholar 

  48. Chen JW, Gombart ZJ, Rogers S, Gardiner SK, Cecil S, Bullock RM (2011) Pupillary reactivity as an early indicator of increased intracranial pressure: the introduction of the Neurological Pupil index. Surg Neurol Int 2:82

    Article  CAS  Google Scholar 

  49. Robba C, Pozzebon S, Moro B, Vincent JL, Creteur J, Taccone FS (2020) Multimodal non-invasive assessment of intracranial hypertension: an observational study. Crit Care 24:379

    Article  Google Scholar 

  50. The Brain Trauma Foundation (2000) The American Association of Neurological Surgeons. The Joint section on neurotrauma and critical care. Intracranial pressure treatment threshold. J Neurotrauma 17:493–495

  51. Brain Trauma F, American Association of Neurological S, Congress of Neurological S, Joint Section on N, Critical Care AC, Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, Manley GT, Nemecek A, Newell DW, Rosenthal G, Schouten J, Shutter L, Timmons SD, Ullman JS, Videtta W, Wilberger JE, Wright DW (2007) Guidelines for the management of severe traumatic brain injury. VIII. Intracranial pressure thresholds. J Neurotrauma 24(Suppl 1):S55–58

  52. Chambers IR, Treadwell L, Mendelow AD (2001) Determination of threshold levels of cerebral perfusion pressure and intracranial pressure in severe head injury by using receiver-operating characteristic curves: an observational study in 291 patients. J Neurosurg 94:412–416

    Article  CAS  Google Scholar 

  53. Depreitere B, Citerio G, Smith M, Adelson PD, Aries MJ, Bleck TP, Bouzat P, Chesnut R, De Sloovere V, Diringer M, Dureanteau J, Ercole A, Hawryluk G, Hawthorne C, Helbok R, Klein SP, Neumann JO, Robba C, Steiner L, Stocchetti N, Taccone FS, Valadka A, Wolf S, Zeiler FA, Meyfroidt G (2021) Cerebrovascular autoregulation monitoring in the management of adult severe traumatic brain injury: a Delphi Consensus of Clinicians. Neurocrit Care 34:731–738

    Article  CAS  Google Scholar 

  54. Rosner MJ, Rosner SD, Johnson AH (1995) Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg 83:949–962

    Article  CAS  Google Scholar 

  55. Chesnut R, Aguilera S, Buki A, Bulger E, Citerio G, Cooper DJ, Arrastia RD, Diringer M, Figaji A, Gao G, Geocadin R, Ghajar J, Harris O, Hoffer A, Hutchinson P, Joseph M, Kitagawa R, Manley G, Mayer S, Menon DK, Meyfroidt G, Michael DB, Oddo M, Okonkwo D, Patel M, Robertson C, Rosenfeld JV, Rubiano AM, Sahuquillo J, Servadei F, Shutter L, Stein D, Stocchetti N, Taccone FS, Timmons S, Tsai E, Ullman JS, Vespa P, Videtta W, Wright DW, Zammit C, Hawryluk GWJ (2020) A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med 46:919–929

    Article  Google Scholar 

  56. Hawryluk GWJ, Aguilera S, Buki A, Bulger E, Citerio G, Cooper DJ, Arrastia RD, Diringer M, Figaji A, Gao G, Geocadin R, Ghajar J, Harris O, Hoffer A, Hutchinson P, Joseph M, Kitagawa R, Manley G, Mayer S, Menon DK, Meyfroidt G, Michael DB, Oddo M, Okonkwo D, Patel M, Robertson C, Rosenfeld JV, Rubiano AM, Sahuquillo J, Servadei F, Shutter L, Stein D, Stocchetti N, Taccone FS, Timmons S, Tsai E, Ullman JS, Vespa P, Videtta W, Wright DW, Zammit C, Chesnut RM (2019) A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med 45:1783–1794

    Article  Google Scholar 

  57. Zeiler FA, Ercole A, Czosnyka M, Smielewski P, Hawryluk G, Hutchinson PJA, Menon DK, Aries M (2020) Continuous cerebrovascular reactivity monitoring in moderate/severe traumatic brain injury: a narrative review of advances in neurocritical care. Br J Anaesth 2020:2

    Google Scholar 

  58. Czosnyka M, Brady K, Reinhard M, Smielewski P, Steiner LA (2009) Monitoring of cerebrovascular autoregulation: facts, myths, and missing links. Neurocrit Care 10:373–386

    Article  Google Scholar 

  59. Tas J, Beqiri E, van Kaam RC, Czosnyka M, Donnelly J, Haeren RH, van der Horst ICC, Hutchinson PJ, van Kuijk SMJ, Liberti AL, Menon DK, Hoedemaekers CWE, Depreitere B, Smielewski P, Meyfroidt G, Ercole A, Aries MJH (2021) Targeting autoregulation-guided cerebral perfusion pressure after traumatic brain injury (COGiTATE): a feasibility randomized controlled clinical trial. J Neurotrauma 38:2790–2800

    Article  Google Scholar 

  60. Lazaridis C, DeSantis SM, Smielewski P, Menon DK, Hutchinson P, Pickard JD, Czosnyka M (2014) Patient-specific thresholds of intracranial pressure in severe traumatic brain injury. J Neurosurg 120:893–900

    Article  Google Scholar 

  61. Zeiler FA, Ercole A, Cabeleira M, Beqiri E, Zoerle T, Carbonara M, Stocchetti N, Menon DK, Lazaridis C, Smielewski P, Czosnyka M, Participants C-THRIS-S, Investigators (2021) Patient-specific ICP epidemiologic thresholds in adult traumatic brain injury: a CENTER-TBI validation study. J Neurosurg Anesthesiol 33:28–38

    Article  Google Scholar 

  62. Doron O, Barnea O, Stocchetti N, Or T, Nossek E, Rosenthal G (2020) Cardiac-gated intracranial elastance in a swine model of raised intracranial pressure: a novel method to assess intracranial pressure-volume dynamics. J Neurosurg 134:1650–1657

    Article  Google Scholar 

  63. Portella G, Cormio M, Citerio G (2002) Continuous cerebral compliance monitoring in severe head injury: its relationship with intracranial pressure and cerebral perfusion pressure. Acta Neurochir Suppl 81:173–175

    CAS  Google Scholar 

  64. Piper I, Dunn L, Contant C, Yau Y, Whittle I, Citerio G, Kiening K, Schvning W, Ng S, Poon W, Enblad P, Nilsson P, Brain ITG (2000) Multi-centre assessment of the Spiegelberg compliance monitor: preliminary results. Acta Neurochir Suppl 76:491–494

    CAS  Google Scholar 

  65. Jin SC, Choi BS, Kim JS (2019) The RAP index during intracranial pressure monitoring as a clinical guiding for surgically treated aneurysmal subarachnoid hemorrhage: consecutive series of single surgeon. Acute Crit Care 34:71–78

    Article  Google Scholar 

  66. Hu X, Xu P, Asgari S, Vespa P, Bergsneider M (2010) Forecasting ICP elevation based on prescient changes of intracranial pressure waveform morphology. IEEE Trans Biomed Eng 57:1070–1078

    Article  Google Scholar 

  67. The Brain Trauma Foundation (2000) The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Critical pathway for the treatment of established intracranial hypertension. J Neurotrauma 17:537–538

  68. Chesnut RM, Videtta W (2020) Situational intracranial pressure management: an argument against a fixed treatment threshold. Crit Care Med 48:1214–1216

    Article  Google Scholar 

  69. Lazaridis C, Goldenberg FD (2020) Intracranial pressure in traumatic brain injury: from thresholds to heuristics. Crit Care Med 48:1210–1213

    Article  Google Scholar 

  70. Tadevosyan A, Kornbluth J (2021) Brain herniation and intracranial hypertension. Neurol Clin 39:293–318

    Article  Google Scholar 

  71. Budohoski KP, Czosnyka M, Kirkpatrick PJ, Smielewski P, Steiner LA, Pickard JD (2013) Clinical relevance of cerebral autoregulation following subarachnoid haemorrhage. Nat Rev Neurol 9:152–163

    Article  CAS  Google Scholar 

Download references

Funding

PH is supported by the NIHR Biomedical Research Centre, Cambridge, NIHR Senior Investigator Award, NIHR Medtech Co-operative for Brain Injury, NIHR Research Group on Global Neurotrauma and the Royal College of Surgeons of England. AK is supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014), Wellcome Trust Institutional Strategic Support Fund (University of Cambridge), NIHR Medtech Co-operative for Brain Injury, and NIHR Global Health Research Group on Neurotrauma.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gregory W. J. Hawryluk.

Ethics declarations

Conflict of interest

No relevant conflicts of interest were reported by any author.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: Modifications have been made to the Affiliations. Full information regarding the corrections made can be found in the erratum/correction for this article.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hawryluk, G.W.J., Citerio, G., Hutchinson, P. et al. Intracranial pressure: current perspectives on physiology and monitoring. Intensive Care Med 48, 1471–1481 (2022). https://doi.org/10.1007/s00134-022-06786-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-022-06786-y

Keywords

Navigation