Intracranial Pressure Monitoring and Management
Issued Date
2022-06-09
Resource Type
Scopus ID
2-s2.0-105024740276
Journal Title
Neurocritical Care
Start Page
6
End Page
31
Rights Holder(s)
SCOPUS
Bibliographic Citation
Neurocritical Care (2022) , 6-31
Suggested Citation
Viarasilpa T., Francoeur C.L., Mayer S.A. Intracranial Pressure Monitoring and Management. Neurocritical Care (2022) , 6-31. 31. doi:10.1017/9781108907682.002 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/113612
Title
Intracranial Pressure Monitoring and Management
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Author's Affiliation
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Abstract
Intracranial hypertension is a life-threatening condition that if left unchecked can lead to brain herniation, cerebral ischemia, and brain death. Intracranial pressure (ICP) monitoring is frequently helpful for patient management. If placed, the monitor should be inserted in comatose patients at high risk for elevated ICP. ICP values, trends, and waveforms should be analyzed in conjunction with cerebral perfusion pressure (CPP) to guide therapy. Patients with elevated ICP can be managed using a tiered strategy that emphasizes cerebral spinal fluid drainage, sedation, and CPP optimization (tier one) prior to initiating bolus osmotherapy, hyperventilation, or paralysis (tier two). Multimodality monitoring therapy is a promising strategy that can detect secondary brain injury early and allow individualized treatment. Tier-three strategies for superrefractory ICP elevation include decompressive craniectomy, hypothermia, and pentobarbital infusion. Of these, craniectomy appears to be the most effective measure for reducing mortality, especially in younger patients.