Intracranial Pressure Monitoring in Traumatic Brain Injury: Start Ventricular or Parenchymal?

Excerpt

Despite ongoing debate over the merits of intracranial pressure (ICP) monitoring, ICP remains fundamental in the approach to severe traumatic brain injury (TBI). The ICP-based paradigm is endorsed by guidelines and appears to be the dominant way of practicing (in high-income countries at least [1‐3]). The question discussed here is as follows: Is the choice of extraventricular drain (EVD) versus an intraparenchymal monitor (IPM) merely a matter of certain patient features in combination with preferences, and convenience of an operator? Or the device may independently contribute to patient outcomes, and consequently, choice ought to be informed accordingly? I assume that most of us would not consider device choice as an independent factor. Bales et al. [4] shared that assumption; however, their analyses proved them wrong. Before delving in, take stock of recent survey data from European centers. One-third of the participants indicated only IPM use, whereas < 10% indicated that they used only EVDs. In centers that used both, IPMs were used routinely, with drains placed either when the ventricles were enlarged or for cerebrospinal fluid (CSF) diversion [3]. …