Medical Management of Elevated Intracranial Pressure

Neurotrauma ◽  
2019 ◽  
pp. 1-8
Author(s):  
Courtney Pendleton ◽  
Jack Jallo
Keyword(s):  
Intracranial Pressure ◽  
Medical Management ◽  
Elevated Intracranial Pressure ◽  
Icp Monitoring ◽  
Head Ct ◽  
Multiple Strategies ◽  
Brain Trauma Foundation ◽  
Abnormal Head ◽  
Patient Families ◽  
The Brain

Elevated intracranial pressure (ICP) may be a sequelae of head trauma, as well as cerebral infarcts and spontaneous intracranial hemorrhages. It is a commonly seen conundrum in neurosurgical practice. Management of elevated ICP is guided by etiology, patient factors, and guidelines for medical and operative treatment. The Brain Trauma Foundation guidelines recommend ICP monitoring in patients with a Glasgow Coma Scale score of less than 8 and an abnormal head CT, or in patients with a normal head CT who meet other inclusion criteria. Once ICP monitoring is begun, multiple strategies for maintaining a goal below 20 are recognized and may be added in a stepwise fashion and continued concurrently. Failure of medical therapy to control ICP may require operative intervention. At the time of initial consultation and throughout medical management of ICP, frank discussions with patient families is essential to accurately communicate prognosis and set expectations for clinical outcomes.

Surgical Treatment of Raised Intracranial Pressure

Neurotrauma ◽  
2019 ◽  
pp. 9-16
Author(s):  
Mohamed A. Zaazoue ◽  
Richard B. Rodgers
Keyword(s):  
Emergency Department ◽  
Intracranial Pressure ◽  
External Ventricular Drain ◽  
Altered Mental Status ◽  
Management Plan ◽  
Raised Intracranial Pressure ◽  
Icp Monitoring ◽  
Surgical Interventions ◽  
Head Ct ◽  
Medical Interventions

Traumatic brain injury (TBI) is a common problem encountered in the emergency department, and neurosurgeons are typically involved early in the management. Prompt physical examination and head CT are crucial to assess TBI patients and determine their management plan. Intracranial pressure (ICP) monitoring is indicated for patients with altered mental status and abnormal imaging. ICP management is a tiered approach, with early tiers involving nonsurgical, and medical interventions. For patients with uncontrolled elevation of ICP, there are three possible surgical interventions: external ventricular drain placement, evacuation of mass lesion, and/or decompressive craniectomy (unilateral or bilateral). Finally, when patients who underwent craniectomy recover from the acute phase of TBI, cranioplasty is performed for cosmetic purposes and potential neurological benefit.

Decreased risk of acute kidney injury with intracranial pressure monitoring in patients with moderate or severe brain injury

2013 ◽  
Vol 119 (5) ◽  
pp. 1228-1232 ◽  
Author(s):  
Jingsong Zeng ◽  
Wusong Tong ◽  
Ping Zheng
Keyword(s):  
Acute Kidney Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Cystatin C ◽  
Kidney Injury ◽  
Control Group ◽  
Icp Monitoring ◽  
Blood Concentrations ◽  
Brain Trauma Foundation ◽  
Monitoring Group

Object The authors undertook this study to evaluate the effects of continuous intracranial pressure (ICP) monitoring–directed mannitol treatment on kidney function in patients with moderate or severe traumatic brain injury (TBI). Methods One hundred sixty-eight patients with TBI were prospectively assigned to an ICP monitoring group or a conventional treatment control group based on the Brain Trauma Foundation guidelines. Clinical data included the dynamic changes of patients' blood concentrations of cystatin C, creatinine (Cr), and blood urea nitrogen (BUN); mannitol use; and 6-month Glasgow Outcome Scale (GOS) scores. Results There were no statistically significant differences with respect to hospitalized injury, age, or sex distribution between the 2 groups. The incidence of acute kidney injury (AKI) was higher in the control group than in the ICP monitoring group (p < 0.05). The mean mannitol dosage in the ICP monitoring group (443 ± 133 g) was significantly lower than in the control group (820 ± 412 g) (p < 0.01), and the period of mannitol use in the ICP monitoring group (3 ± 3.8 days) was significantly shorter than in the control group (7 ± 2.3 days) (p < 0.01). The 6-month GOS scores in the ICP monitoring group were significantly better than in the control group (p < 0.05). On the 7th, 14th, and 21st days after injury, the plasma cystatin C and Cr concentrations in the ICP-monitoring group were significantly higher than the control group (p < 0.05). Conclusions In patients with moderate and severe TBI, ICP-directed mannitol treatment demonstrated a beneficial effect on reducing the incidence of AKI compared with treatment directed by neurological signs and physiological indicators.

Computed Tomographic Brain Density Measurement as a Predictor of Elevated Intracranial Pressure in Blunt Head Trauma

2007 ◽  
Vol 73 (10) ◽  
pp. 1023-1026 ◽  
Author(s):  
Kenji Inaba ◽  
Pedro G.R. Teixeira ◽  
Jean-Stephane David ◽  
Carlos Brown ◽  
Ali Salim ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Injury Severity ◽  
Density Measurement ◽  
Elevated Intracranial Pressure ◽  
Icp Monitoring ◽  
Brain Ct ◽  
Blunt Head Trauma ◽  
Brain Density

There are no independent computed tomography (CT) findings predictive of elevated intracranial pressure (ICP). The purpose of this study was to evaluate brain density measurement on CT as a predictor of elevated ICP or decreased cerebral perfusion pressure (CPP). A prospectively collected database of patients with acute traumatic brain injury was used to identify patients who had a brain CT followed within 2 hours by ICP measurement. Blinded reviewers measured mean density in Hounsfield Units (HU) within a 100-mm2 elliptical region at four standardized positions. Brain density measurement was compared for patients with an ICP of 20 or greater versus less than 20 mm Hg and CPP of 70 or greater versus less than 70 mm Hg. During a 2-year period, 47 patients had ICP monitoring after brain CT. Average age was 40 ± 18 years old; 93.6 per cent were male; mean Injury Severity Score was 25 ± 10; and Glasgow Coma Scale was 6 ± 4. There was no difference in brain density measurement for observer 1, ICP less than 20 (26.3 HU) versus ICP 20 or greater (27.4 HU, P = 0.545) or for CPP less than 70 (27.1 HU) versus CPP 70 or greater (26.2, P = 0.624). Similarly, there was no difference for observer 2, ICP less than 20 (26.8 HU) versus ICP 20 or greater (27.4, P = 0.753) and CPP less than 70 (27.6 HU) versus CPP 70 or greater (26.2, P = 0.436). CT-measured brain density does not correlate with elevated ICP or depressed CPP and cannot predict patients with traumatic brain injury who would benefit from invasive ICP monitoring.

Simultaneous measurements of intracranial pressure parameters in the epidural space and in brain parenchyma in patients with hydrocephalus

2010 ◽  
Vol 113 (6) ◽  
pp. 1317-1325 ◽  
Author(s):  
Per Kristian Eide ◽  
Wilhelm Sorteberg
Keyword(s):  
Intracranial Pressure ◽  
Epidural Space ◽  
Pulse Pressure ◽  
Brain Parenchyma ◽  
Pressure Amplitude ◽  
Icp Monitoring ◽  
Simultaneous Measurements ◽  
Pulsatile Pressure ◽  
The Mean ◽  
The Brain

Object In this study, the authors compare simultaneous measurements of static and pulsatile pressure parameters in the epidural space and brain parenchyma of hydrocephalic patients. Methods Simultaneous intracranial pressure (ICP) signals from the epidural space (ICPEPI) and the brain parenchyma (ICPPAR) were compared in 12 patients undergoing continuous ICP monitoring as part of their diagnostic workup for hydrocephalus. The static ICP was characterized by mean ICP and the frequency of B waves quantified in the time domain, while the pulsatile ICP was determined from the cardiac beat–induced single ICP waves and expressed by the ICP pulse pressure amplitude (dP) and latency (dT; that is, rise time). Results The 12 patients underwent a median of 22.5 hours (range 5.9–24.8 hours) of ICP monitoring. Considering the total recording period of each patient, the mean ICP (static ICP) differed between the 2 compartments by ≥ 5 mm Hg in 8 patients (67%) and by ≥ 10 mm Hg in 4 patients (33%). In contrast, for every patient the ICP pulse pressure readings from the 2 compartments showed near-identical results. Consequently, when sorting patients to shunt/no shunt treatment according to pulsatile ICP values, selection was independent of sensor placement. The frequency of B waves also compared well between the 2 compartments. Conclusions The pulsatile ICP is measured with equal confidence from the ICPEPI and ICPPAR signals. When using the pulsatile ICP for evaluation of hydrocephalic patients, valid measurements may thus be obtained from pressure monitoring in the epidural space. Recorded differences in the mean ICP between the epidural space and the brain parenchyma are best explained by differences in the zero setting of different sensors.

PVDF Sensor: Design and Development for Use as Intracranial Pressure Monitoring Device

2009 ◽  
Author(s):  
V. Vijaywargi ◽  
R. Proffitt ◽  
P. Mane ◽  
K. Mossi ◽  
K. Ward ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Intracranial Pressure ◽  
Applied Pressure ◽  
Monitoring Device ◽  
Risk Of Infection ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
High Frequencies ◽  
Novel Method ◽  
The Brain

The brain is surrounded by cerebrospinal fluid, and when a brain tumor or a traumatic brain injury has occurred, intracranial pressure, ICP, is developed. Monitoring ICP non-invasively is a challenge. Currently, a probe is inserted through the skull, running the risk of infection, bleeding, and damage to the brain tissue with residual neurologic effects. A novel method to measure ICP using actuators and sensors has been proposed where the skull is vibrated at high frequencies and the receiving signal is measured at the surface eyelid. A design of experiments approach is used to develop the sensor part of the ICP monitoring device so that gain can be maximized using factors such as area, thickness, electrode, and applied pressure. In addition, sensor packaging is optimized to minimize dampening of the signal and ensure durability, reliability, and repeatability of the measurements. Results of this study showed that for a range of areas and thicknesses with Cu-Ni electrodes packaged with super strength durable tape are the optimum factors for the ICP sensor. These parameters are then incorporated into a design that allows ease of application and consistency of the measurements.

scholarly journals Endovascular Management of an Embedded Intracranial Knife

2007 ◽  
Vol 34 (4) ◽  
pp. 460-463 ◽  
Author(s):  
T E Darsaut ◽  
R A Ashforth ◽  
M M Chow ◽  
J M Findlay
Keyword(s):  
Intracranial Pressure ◽  
Endovascular Therapy ◽  
Medical Management ◽  
Anterior Cerebral Artery ◽  
Injured Patient ◽  
Severely Injured ◽  
Elevated Intracranial Pressure ◽  
Endovascular Management ◽  
Contrast Extravasation ◽  
Severely Injured Patient

Background:Endovascular therapy (ET) is infrequently used in the setting of acute penetrating intracranial trauma.Methods:We report a case where ET was used immediately prior to and following removal of an embedded intracranial knife, which was found to be disrupting the anterior cerebral artery.Results:The proximal vessel was coiled and angiographically occluded and then the knife was removed with the microcatheter in place. Immediate angiography allowed us to see and quickly treat the contrast extravasation with further coiling. Despite full medical management, the patient died of elevated intracranial pressure.Conclusion:In this severely injured patient, endovascular therapy represented the most suitable means to attempt safe removal of the knife.

scholarly journals The "Brain Stethoscope": A Non-Invasive Method for Detecting Elevated Intracranial Pressure

Cureus ◽  
2021 ◽  
Author(s):  
Nathan Kostick ◽  
Kim Manwaring ◽  
Rajkumar Dhar ◽  
Richard Sandler ◽  
Hansen Mansy
Keyword(s):  
Intracranial Pressure ◽  
Elevated Intracranial Pressure ◽  
Non Invasive ◽  
Invasive Method ◽  
The Brain

scholarly journals Adherence to brain trauma foundation guidelines for intracranial pressure monitoring in severe traumatic brain injury and the effect on outcome: A population-based study

2020 ◽  
Vol 11 ◽  
pp. 118
Author(s):  
Yahya H. Khormi ◽  
Ambikaipakan Senthilselvan ◽  
Cian O’kelly ◽  
David Zygun
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Severe Traumatic Brain Injury ◽  
Alcohol Intoxication ◽  
Brain Trauma ◽  
Adherence Rate ◽  
Icp Monitoring ◽  
Brain Trauma Foundation ◽  
Severity Scores

Background: Severe traumatic brain injury (TBI) is a significant cause of death and disability. The objective of this study was to provide an overview of whether adherence to brain trauma foundation (BTF) guidelines improved outcomes following TBI utilizing intracranial pressure (ICP) monitoring. Methods: This cohort study between 2000 and 2013 involved 1848 patients who sustained severe blunt TBI. Outcomes were correlated with whether or not ICP monitoring was utilized based on BTF guidelines. Results: The BTF guideline adherence rate for utilizing ICP monitoring in patients with TBI was 30% in 1848 patients. Adherence rates positively correlated with younger age, high injury severity scores, lower Glasgow Coma Scores, abnormal computed tomography scans of the head, performance of a craniotomy, neurocritical care unit admission, the lack of alcohol intoxication, and the absence of a cardiac arrest. Greater adherence to BTF guidelines was associated with higher mortality rates (OR 2.01, 95% CI: 1.56–2.59, P < 0.001), and increase ICU and hospital lengths of stay (P < 0.001). Conclusion: Adherence rates to BTF guidelines for ICP monitoring in patients with severe TBI were low. Further, these rates varied across centers and were correlated with higher mortality and morbidity rates. Although ICP insertion may be an indicator of TBI severity, the current BTF criteria for insertion of ICP monitors may fail to identify patients likely to benefit.

Ultrasound of the Optic Nerve Does Not Appear to Be a Consistently Reliable or Generalizable Method to Monitor Changes in Intracranial Pressure

2021 ◽  
pp. 088506662110217
Author(s):  
Christine Butts ◽  
Jason Wilson ◽  
Lindsay Lasseigne ◽  
Evrim Oral ◽  
Nicole Kaban
Keyword(s):  
Optic Nerve ◽  
Intracranial Pressure ◽  
Optic Nerve Sheath Diameter ◽  
Repeated Measurements ◽  
Icp Monitoring ◽  
Convenience Sample ◽  
Naturally Occurring ◽  
Nerve Sheath ◽  
The Right ◽  
The Brain

Objective: Invasive intracranial pressure (ICP) monitoring is the gold standard, but is not always readily accessible or practical. Ultrasound of the optic nerve sheath diameter (ONSD) has been proposed for detecting both elevation and change in the ICP. Our study is a prospective observational trial that seeks to determine if ultrasound can be reliably used to identify changes in ICP with naturally occurring variations in patient care. Methods: A convenience sample of patients with invasive ICP monitoring were enrolled. Patients were identified prior to interventions that were suspected to cause a change in ICP. Measurement of ICP and ONSD was obtained prior to the intervention, with repeated measurements of both variables obtained immediately following the intervention. Results: 36 total patients were enrolled. There was a positive correlation between the ICP and the right ONSD (r = 0.255, P = 0.0003) and the ICP and the left ONSD (r = 0.274, P < 0.0001). There was no statistically significant relationship between the change in either the ICP and the right ONSD (r −0.2 P = 0.282) or left ONSD (r 0.05 P = 0.805). The location of the lesion in the brain appears to significantly affect discordance between the ONSD and the ICP. Conclusions: Ultrasound of the ONSD has shown promise as both a marker of elevated ICP and as a method to identify changes in pressure. Although the size of the ONSD and the measurement of ICP were correlated in our study, the ability to follow changes in ICP was not statistically significant. This indicates that use of ultrasound to track changes in ICP cannot be generalized and may be limited to specific circumstances. The location of the intracranial pathology appears to be a significant factor in discordance between the ICP and ONS diameter.

Decreased Intracranial Pressure Monitor Use at Level II Trauma Centers is Associated with Increased Mortality

2012 ◽  
Vol 78 (10) ◽  
pp. 1166-1171 ◽  
Author(s):  
Galinos Barmparas ◽  
Matthew Singer ◽  
Eric Ley ◽  
Rex Chung ◽  
Darren Malinoski ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Trauma Center ◽  
Injury Severity ◽  
Regression Modeling ◽  
Trauma Centers ◽  
Icp Monitoring ◽  
Pressure Monitor ◽  
Brain Trauma Foundation ◽  
Level Ii ◽  
Level I

Previous investigations suggest outcome differences at Level I and Level II trauma centers. We examined use of intracranial pressure (ICP) monitors at Level I and Level II trauma centers after traumatic brain injury (TBI) and its effect on mortality. The 2007 to 2008 National Trauma Databank was reviewed for patients with an indication for ICP monitoring based on Brain Trauma Foundation (BTF) guidelines. Demographic and clinical outcomes at Level I and Level II centers were compared by regression modeling. Overall, 15,921 patients met inclusion criteria; 11,017 were admitted to a Level I and 4,904 to a Level II trauma center. Patients with TBI admitted to a Level II trauma center had a lower rate of Injury Severity Score greater than 16 (80 vs 82%, P < 0.01) and lower frequency of head Abbreviated Injury Score greater than 3 (80 vs 82%, P < 0.01). After regression modeling, patients with TBI admitted to a Level II trauma center were 31 per cent less likely to receive an ICP monitor (adjusted odds ratio [AOR], 0.69; P < 0.01) and had a significantly higher mortality (AOR, 1.12; P < 0.01). Admission to a Level II trauma center after severe TBI is associated with a decreased use of ICP monitoring in patients who meet BTF criteria as well as an increased mortality. These differences should be validated prospectively to narrow these discrepancies in care and outcomes between Level I and Level II centers.

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