This Article Full Text Full Text (PDF) CME: Take the course for this article: Intracranial Pressure Monitoring in Traumatic Brain Injury Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Smith, M. Search for Related Content PubMed PubMed Citation Articles by Smith, M. Related Collections Trauma Neuroanesthesia Monitoring (Non-cardiac)

---

NEUROSURGICAL ANESTHESIOLOGY

Monitoring Intracranial Pressure in Traumatic Brain Injury

From the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK.

Address correspondence and reprint requests to Dr. Martin Smith, MBBS, FRCA, Consultant in Neuroanaesthesia and Neurocritical Care, Honorary Reader in Anaesthesia and Critical Care, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, Queen Square, London, WC1N 3BG. Address e-mail to martin.smith{at}uclh.nhs.uk.

Abstract

Increased intracranial pressure (ICP) is an important cause of secondary brain injury, and ICP monitoring has become an established component of brain monitoring after traumatic brain injury. ICP cannot be reliably estimated from any specific clinical feature or computed tomography finding and must actually be measured. Different methods of monitoring ICP have been described but intraventricular catheters and microtransducer systems are most widely used in clinical practice. ICP is a complex variable that links ICP and cerebral perfusion pressure and provides additional information from identification and analysis of pathologic ICP wave forms. ICP monitoring can also be augmented by measurement of indices describing cerebrovascular pressure reactivity and pressure-volume compensatory reserve. There is considerable variability in the use of ICP monitoring and treatment modalities among head injury centers. However, there is a large body of clinical evidence supporting the use of ICP monitoring to detect intracranial mass lesions early, guide therapeutic interventions, and assess prognosis, and it is recommended by consensus guidelines for head injury management. There remains a need for a prospective, randomized, controlled trial to identify the value of ICP monitoring and management after head injury.