Escalation therapy in severe traumatic brain injury: how long is intracranial pressure monitoring necessary?

Pasquale Anania, Denise Battaglini, John P. Miller, Alberto Balestrino, Alessandro Prior, Alessandro D’Andrea, Filippo Badaloni, Paolo Pelosi, Chiara Robba, Gianluigi Zona, Pietro Fiaschi

Research output: Contribution to journalReview articlepeer-review

Abstract

Traumatic brain injury frequently causes an elevation of intracranial pressure (ICP) that could lead to reduction of cerebral perfusion pressure and cause brain ischemia. Invasive ICP monitoring is recommended by international guidelines, in order to reduce the incidence of secondary brain injury; although rare, the complications related to ICP probes could be dependent on the duration of monitoring. The aim of this manuscript is to clarify the appropriate timing for removal and management of invasive ICP monitoring, in order to reduce the risk of related complications and guarantee adequate cerebral autoregulatory control. There is no universal consensus concerning the duration of invasive ICP monitoring and its related complications, although the pertinent literature seems to show that the longer is the monitoring maintenance, the higher is the risk of technical issues. Besides, upon 72 h of normal ICP values or less than 72 h if the first computed tomography scan is normal (none or minimal signs of injury) and the neurological exam is available (allowing to observe variations and possible occurrence of new-onset pathological response), the removal of invasive ICP monitoring can be justified. The availability of non-invasive monitoring systems should be considered to follow up patients’ clinical course after invasive ICP probe removal or for substituting the invasive monitoring in case of contraindication to its placement. Recently, optic nerve sheath diameter and straight sinus systolic flow velocity evaluation through ultrasound methods showed a good correlation with ICP values, demonstrating their potential role in place of invasive monitoring or in the early weaning phase from the invasive ICP monitoring.

Original languageEnglish
JournalNeurosurgical Review
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • Brain injury
  • Duration
  • ICP
  • Monitoring
  • TBI
  • Weaning

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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