Purpose Of Review: The objective of this review is to provide a comprehensive management protocol for the treatment of intracranial pressure (ICP) crises based on the latest evidence.
Recent Findings: The review discusses updated information on various aspects of critical care management in patients experiencing ICP crises, including mechanical ventilation, fluid therapy, hemoglobin targets, and hypertonic saline infusion, the advantages of ICP monitoring, the critical ICP threshold, and bedside neuromonitoring. All aspects of critical care treatment, including hemodynamic and respiratory support and adjustment of ICP reduction therapy, may impact patient outcomes. ICP monitoring allows ICP values, trends, waveforms, and CPP calculation, which are helpful to guide patient care. Advanced neuromonitoring devices are available at the bedside to diagnose impaired intracranial compliance and intracranial hypertension, assess brain function, and optimize cerebral perfusion. Future research should focus on developing appropriate intervention protocols for both invasive and noninvasive neuromonitoring in managing ICP crisis patients.
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http://dx.doi.org/10.1007/s11910-024-01392-5 | DOI Listing |
Brain Spine
February 2024
Brain Physics Laboratory Division of Neurosurgery Department of Clinical Neurosciences, University of Cambridge, UK.
Introduction: Secondary insults due to high intracranial pressure (ICP), low cerebral perfusion pressure (CPP) and impaired cerebral pressure reactivity (PRx) predict outcome after severe traumatic brain injury (TBI).
Research Question: What is the prevalence, co-occurrence and prognostic importance of secondary insults due to deranged ICP, CPP or PRx after TBI.
Material And Methods: Severe TBI patients requiring ICP monitoring were included.
Neurocrit Care
January 2025
Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Background: Invasive mechanical ventilation can present complex challenges for patients with acute brain injury (ABI) in middle-income countries (MICs). We characterized the impact of country income level on weaning strategies and outcomes in patients with ABI.
Methods: A secondary analysis was performed on a registry of critically ill patients with ABI admitted to 73 intensive care units (ICUs) in 18 countries from 2018 to 2020.
Neurocrit Care
January 2025
Department of Health Research, Medical Technology, SINTEF, Trondheim, Norway.
Background: Optic nerve sheath diameter (ONSD) is a promising noninvasive parameter for intracranial pressure (ICP) assessment. However, in the setting of aneurysmal subarachnoid hemorrhage (aSAH), several previous studies have reported no association between ultrasonically measured ONSD and ICP. In this study, we evaluate ONSD in patients with aSAH using a novel method of automated real-time ultrasonographic measurements and explore whether factors such as having undergone surgery affects its association to ICP.
View Article and Find Full Text PDFPLoS One
January 2025
Department of Intensive Care, Ramsay Générale de Santé, Hôpital privé de la Loire, Saint Etienne, France.
Real-time monitoring of intracranial pressure (ICP) is a routine part of neurocritical care in the management of brain injury. While mainly used to detect episodes of intracranial hypertension, the ICP signal is also indicative of the volume-pressure relationship within the cerebrospinal system, often referred to as intracranial compliance (ICC). Several ICP signal descriptors have been proposed in the literature as surrogates of ICC, but the possibilities of combining these are still unexplored.
View Article and Find Full Text PDFAm J Case Rep
January 2025
Department of Neurosurgery, Denver Health Hospital Authority, Denver, CO, USA.
BACKGROUND Decompressive craniectomy is a common life-saving intervention in the setting of elevated intracranial pressure. Cranioplasty restores the calvarium and intracranial physiology once swelling recedes. Cranioplasty is often thought of as a low-risk intervention.
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