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Intracranial Pressure Monitoring: Fundamental Considerations and Rationale for Monitoring

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Abstract

Traumatic brain injury (TBI) is a major cause of death and disability worldwide. In large part critical care for TBI is focused on the identification and management of secondary brain injury. This requires effective neuromonitoring that traditionally has centered on intracranial pressure (ICP). The purpose of this paper is to review the fundamental literature relative to the clinical application of ICP monitoring in TBI critical care and to provide recommendations on how the technique maybe applied to help patient management and enhance outcome. A PubMed search between 1980 and September 2013 identified 2,253 articles; 244 of which were reviewed in detail to prepare this report and the evidentiary tables. Several important concepts emerge from this review. ICP monitoring is safe and is best performed using a parenchymal monitor or ventricular catheter. While the indications for ICP monitoring are well established, there remains great variability in its use. Increased ICP, particularly the pattern of the increase and ICP refractory to treatment is associated with increased mortality. Class I evidence is lacking on how monitoring and management of ICP influences outcome. However, a large body of observational data suggests that ICP management has the potential to influence outcome, particularly when care is targeted and individualized and supplemented with data from other monitors including the clinical examination and imaging.

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Conflict of interest

Randall Chesnut receives NIH funding. Peter Le Roux receives research funding from Integra Lifesciences, Neurologica, the Dana Foundation, and the NIH; is a consultant for Integra Lifesciences, Codman, Synthes, Neurologica; and is a member of the scientific advisory board of Cerebrotech, Brainsgate, Orsan and Edge Therapeutics. Paul Vespa receives Grant Funding from NIH, DOD; is a consultant for Edge Therapeutics; and has Stock Options with Intouch Health. Walter Videtta receives NIH funding.

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  1. Brain and Spine Center, Suite 370, Medical Science Building, Lankenau Medical Center, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA

    Randall Chesnut, Walter Videtta, Paul Vespa & Peter Le Roux

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  2. Walter Videtta
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  3. Paul Vespa
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  4. Peter Le Roux
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Consortia

The Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring

Corresponding author

Correspondence to Peter Le Roux.

Additional information

The Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring are listed in “Appendix” section.

Appendix: Participants in the International Multi-disciplinary Consensus Conference on Multimodality Monitoring

Appendix: Participants in the International Multi-disciplinary Consensus Conference on Multimodality Monitoring

Peter Le Roux, MD, FACS,

Brain and Spine Center,

Suite 370, Medical Science Building,

Lankenau Medical Center,

100 East Lancaster Avenue, Wynnewood, PA 19096, USA.

Tel: +1 610 642 3005;

Fax: 610 642 3057

lerouxp@mlhs.org

David K Menon MD PhD FRCP FRCA FFICM FMedSci

Head, Division of Anaesthesia, University of Cambridge

Consultant, Neurosciences Critical Care Unit

Box 93, Addenbrooke’s Hospital,

Cambridge CB2 2QQ, UK

dkm13@wbic.cam.ac.uk

Paul Vespa, MD, FCCM, FAAN, FNCS

Professor of Neurology and Neurosurgery

Director of Neurocritical Care

David Geffen School of Medicine at UCLA

Los Angeles, CA 90095 USA

PVespa@mednet.ucla.edu

Giuseppe Citerio, MD

Director NeuroIntensive Care Unit,

Department of Anesthesia and Critical Care

Ospedale San Gerardo, Monza.

Via Pergolesi 33, Monza 20900, Italy

g.citerio@hsgerardo.org

Mary Kay Bader RN, MSN, CCNS, FAHA, FNCS

Neuro/Critical Care CNS

Mission Hospital

Mission Viejo CA 92691, USA

Marykay.Bader@stjoe.org

Gretchen M. Brophy, PharmD, BCPS, FCCP, FCCM

Professor of Pharmacotherapy & Outcomes Science and Neurosurgery

Virginia Commonwealth University

Medical College of Virginia Campus

410 N. 12th Street

Richmond, Virginia 23298-0533 USA

gbrophy@vcu.edu

Michael N. Diringer, MD

Professor of Neurology, Neurosurgery & Anesthesiology

Chief, Neurocritical Care Section

Washington University

Dept. of Neurology, Campus Box 8111

660 S Euclid Ave

St Louis, MO 63110 USA

diringerm@neuro.wustl.edu

Nino Stocchetti, MD

Professor of Anesthesia and Intensive Care

Department of physiopathology and transplant,

Milan University

Director Neuro ICU

Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico

Via F Sforza, 35 20122 Milan Italy

e-mail stocchet@policlinico.mi.it

Walter Videtta, MD

ICU Neurocritical Care

Hospital Nacional ‘Prof. a. Posadas’

El Palomar - Pcia. de Buenos Aires

Argentina

wvidetta@ar.inter.net

Rocco Armonda, MD

Department of Neurosurgery

MedStar Georgetown University Hospital

Medstar Health, 3800 Reservoir Road NW

Washington DC 20007

USA

Rocco.Armonda@gmail.com

Neeraj Badjatia, MD

Department of Neurology

University of Maryland Medical Center,

22 S Greene St

Baltimore, MD, 21201

USA

nbadjatia@umm.edu

Julian Boesel, MD

Department of Neurology

Ruprect-Karls University

Hospital Heidelberg, Im Neuenheimer Feld 400,

D-69120 Heidelberg,

Germany

Julian.Boesel@med.uni-heidelberg.de

Randal Chesnut, MD, FCCM, FACS

Harborview Medical Center,

University of Washington Mailstop 359766

325 Ninth Ave,

Seattle WA 98104-2499

USA

chesnutr@u.washington.edu

Sherry Chou, MD, MMSc

Department of Neurology,

Brigham and Women’s Hospital

75 Francis Street,

Boston MA 02115

USA

schou1@partners.org

Jan Claassen, MD, PhD, FNCS

Assistant Professor of Neurology and Neurosurgery

Head of Neurocritical Care and Medical Director of the Neurological Intensive Care Unit

Columbia University College of Physicians & Surgeons

177 Fort Washington Avenue, Milstein 8 Center room 300,

New York, NY 10032

USA

jc1439@cumc.columbia.edu

Marek Czosnyka, PhD

Department of Neurosurgery

University of Cambridge,

Addenbrooke’s Hospital, Box 167

Cambridge, CB20QQ

United Kingdom

mc141@medschl.cam.ac.uk

Michael De Georgia, MD

Professor of Neurology

Director, Neurocritical Care Center

Co-Director, Cerebrovascular Center

University Hospital Case Medical Center

Case Western Reserve University School of Medicine

11100 Euclid Avenue

Cleveland, Ohio 44106

michael.degeorgia@uhhospitals.org

Anthony Figaji, MD, PhD

Head of Pediatric Neurosurgery

University of Cape Town

617 Institute for Child Health

Red Cross Children’s Hospital

Rondebosch, 7700 Cape Town,

South Africa

anthony.figaji@uct.ac.za

Jennifer Fugate, DO

Department of Neurology,

Mayo Clinic,

200 First Street SW

Rochester, MN 55905

Fugate.Jennifer@mayo.edu

Raimund Helbok, MD

Department of Neurology, Neurocritical Care Unit

Innsbruck Medical University,

Anichstr.35, 6020

Innsbruck,

Austria

raimund.helbok@uki.at

David Horowitz, MD

Associate Chief Medical Officer

University of Pennsylvania Health System,

3701 Market Street

Philadelphia, PA, 19104

USA

david.horowitz@uphs.upenn.edu

Peter Hutchinson, MD

Professor of Neurosurgery

NIHR Research Professor

Department of Clinical Neurosciences

University of Cambridge

Box 167 Addenbrooke’s Hospital

Cambridge CB2 2QQ

United Kingdom

pjah2@cam.ac.uk

Monisha Kumar, MD

Department of Neurology

Perelman School of Medicine, University of Pennsylvania,

3 West Gates

3400 Spruce Street

Philadelphia, PA, 19104

USA

monisha.kumar@uphs.upenn.edu

Molly McNett, RN, PhD

Director, Nursing Research

The MetroHealth System

2500 MetroHealth Drive,

Cleveland, OH 44109

USA

mmcnett@metrohealth.org

Chad Miller, MD

Division of Cerebrovascular Diseases and Neurocritical Care

The Ohio State University

395 W. 12th Ave, 7th Floor

Columbus, OH 43210

ChadM.Miller@osumc.edu

Andrew Naidech, MD, MSPH

Department of Neurology

Northwestern University Feinberg SOM 710

N Lake Shore Drive, 11th floor

Chicago, IL 60611

ANaidech@nmff.org

Mauro Oddo, MD

Department of Intensive Care Medicine

CHUV University Hospital, BH 08-623

Faculty of Biology and Medicine University of Lausanne

1011 Lausanne, Switzerland

Mauro.Oddo@chuv.ch

DaiWai Olson, RN, PhD

Associate Professor of Neurology, Neurotherapeutics and Neurosurgery

University of Texas Southwestern

5323 Harry Hines Blvd.

Dallas, TX 75390-8897

USA

daiwai.olson@utsouthwestern.edu

Kristine O’Phelan M.D.

Director of Neurocritical Care

Associate Professor, Department of Neurology

University of Miami, Miller School of Medicine

JMH, 1611 NW 12th Ave, Suite 405

Miami, FL, 33136

USA

kophelan@med.miami.edu

Javier Provencio, MD

Associate Professor of Medicine

Cerebrovascular Center and Neuroinflammation Research Center

Lerner College of Medicine

Cleveland Clinic,

9500 Euclid Ave, NC30

Cleveland, OH 44195

USA

provenj@ccf.org

Corina Puppo, MD

Assistant Professor, Intensive Care Unit,

Hospital de Clinicas, Universidad de la República,

Montevideo

Uruguay

coripuppo@gmail.com

Richard Riker, MD

Critical Care Medicine

Maine Medical Center,

22 Bramhall Street

Portland, Maine 04102-3175

USA

RRiker@cmamaine.com

Claudia Robertson, MD

Department of Neurosurgery

Medical Director of Center for Neurosurgical Intensive Care,

Ben Taub Hospital

Baylor College of Medicine,

1504 Taub Loop, Houston, TX 77030

USA

claudiar@bcm.tmc.edu

J. Michael Schmidt, PhD, MSc

Director of Neuro-ICU Monitoring and Informatics

Columbia University College of Physicians and Surgeons

Milstein Hospital 8 Garden South, Suite 331

177 Fort Washington Avenue,

New York, NY 10032

USA

mjs2134@columbia.edu

Fabio Taccone, MD

Department of Intensive Care, Laboratoire de Recherche Experimentale

Erasme Hospital,

Route de Lennik, 808

1070 Brussels

Belgium

ftaccone@ulb.ac.be

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Chesnut, R., Videtta, W., Vespa, P. et al. Intracranial Pressure Monitoring: Fundamental Considerations and Rationale for Monitoring. Neurocrit Care 21 (Suppl 2), 64–84 (2014). https://doi.org/10.1007/s12028-014-0048-y

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