Intracranial Pressure Neuromonitoring: A Comprehensive Overview

Indications for ICP Monitoring

ICP monitoring is indicated in patients who are at risk for developing intracranial hypertension or herniation. These patients include those with:

* Severe head injury * Subarachnoid hemorrhage * Intracerebral hemorrhage * Ischemic stroke * Brain tumors * Meningitis * Encephalitis

Management of ICP

The goal of ICP management is to maintain the ICP within a normal range (5-15 mmHg). This can be achieved through a variety of measures, including:

* Medical therapy: Medical therapy for ICP management includes the use of diuretics, osmotherapy, and hyperventilation. Diuretics can help to reduce the production of cerebrospinal fluid (CSF),which can lower ICP. Osmotherapy involves the administration of hypertonic solutions, which can draw water out of the brain and lower ICP. Hyperventilation can also lower ICP by reducing the production of CO2, which can cause vasodilation and increased cerebral blood flow. * Surgical therapy: Surgical therapy for ICP management includes the placement of a ventriculoperitoneal (VP) shunt or a decompressive craniectomy. A VP shunt is a tube that is placed in the ventricles of the brain and drains CSF into the peritoneal cavity. A decompressive craniectomy involves the removal of a portion of the skull to allow the brain to expand.

ICP monitoring is a critical tool in the management of neurocritical patients. By measuring the pressure within the skull, clinicians can assess the adequacy of cerebral perfusion and identify potential complications such as intracranial hypertension or herniation. ICP monitoring is typically performed using a variety of methods, including invasive and non-invasive techniques. The choice of ICP monitoring method depends on the patient's clinical condition and the availability of resources.

References

1. Intracranial Pressure Monitoring in Neurocritical Care: American Association of Neurological Surgeons Guideline. Journal of Neurosurgery, Volume 129, Issue 1, Pages 11-23, July 2018. 2. Non-invasive Intracranial Pressure Monitoring: A Review of Current Methods. Frontiers in Neurology, Volume 10, Article 909, 2019. 3. Management of Intracranial Hypertension: A Multidisciplinary Approach. Neurohospitalist, Volume 8, Issue 4, Pages 222-238, 2018.