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11-07-2022 | Central Nervous System Trauma | Review

Intracranial pressure: current perspectives on physiology and monitoring

Authors: Gregory W. J. Hawryluk, Giuseppe Citerio, Peter Hutchinson, Angelos Kolias, Geert Meyfroidt, Chiara Robba, Nino Stocchetti, Randall Chesnut

Published in: Intensive Care Medicine | Issue 10/2022

Abstract

Intracranial pressure (ICP) monitoring is now viewed as integral to the clinical care of many life-threatening brain insults, such as severe traumatic brain injury, subarachnoid hemorrhage, and malignant stroke. It serves to warn of expanding intracranial mass lesions, to prevent or treat herniation events as well as pressure elevation which impedes nutrient delivery to the brain. It facilitates the calculation of cerebral perfusion pressure (CPP) and the estimation of cerebrovascular autoregulatory status. Despite advancements in our knowledge emanating from a half century of experience with this technology, important controversies remain related even to fundamental aspects of ICP measurements, including indications for monitoring, ICP treatment thresholds, and management of intracranial hypertension. Here, we review the history of ICP monitoring, the underlying pathophysiology as well as current perspectives on why, when and how ICP monitoring is best used. ICP is typically assessed invasively but a number of emerging, non-invasive technologies with inherently lower risk are showing promise. In selected cases, additional neuromonitoring can be used to assist in the interpretation of ICP monitoring information and adapt directed treatment accordingly. Additional efforts to expand the evidence base relevant to ICP monitoring, related technologies and management remain a high priority in neurosurgery and neurocritical care.

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Title: Intracranial pressure: current perspectives on physiology and monitoring
Authors: Gregory W. J. Hawryluk
Giuseppe Citerio
Peter Hutchinson
Angelos Kolias
Geert Meyfroidt
Chiara Robba
Nino Stocchetti
Randall Chesnut
Publication date: 11-07-2022
Publisher: Springer Berlin Heidelberg
Keywords: Central Nervous System Trauma
Intracranial Hypertension
Care
Hypertension
Published in: Intensive Care Medicine / Issue 10/2022
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-022-06786-y

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Intracranial pressure: current perspectives on physiology and monitoring

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