Abstract
Background: Intracranial pressure (ICP) monitoring has been for decades a cornerstone of traumatic brain injury (TBI) management. Nevertheless, in recent years, its usefulness has been questioned in several reports. A group of neurosurgeons and neurointensivists met to openly discuss, and provide consensus on, practical applications of ICP in severe adult TBI. Methods: A consensus conference was held in Milan on October 5, 2013, putting together neurosurgeons and intensivists with recognized expertise in treatment of TBI. Four topics have been selected and addressed in pro-con presentations: 1) ICP indications in diffuse brain injury, 2) cerebral contusions, 3) secondary decompressive craniectomy (DC), and 4) after evacuation of intracranial traumatic hematomas. The participants were asked to elaborate on the existing published evidence (without a systematic review) and their personal clinical experience. Based on the presentations and discussions of the conference, some drafts were circulated among the attendants. After remarks and further contributions were collected, a final document was approved by the participants. Summary and conclusions: The group made the following recommendations: 1) in comatose TBI patients, in case of normal computed tomography (CT) scan, there is no indication for ICP monitoring; 2) ICP monitoring is indicated in comatose TBI patients with cerebral contusions in whom the interruption of sedation to check neurological status is dangerous and when the clinical examination is not completely reliable. The probe should be positioned on the side of the larger contusion; 3) ICP monitoring is generally recommended following a secondary DC in order to assess the effectiveness of DC in terms of ICP control and guide further therapy; 4) ICP monitoring after evacuation of an acute supratentorial intracranial hematoma should be considered for salvageable patients at increased risk of intracranial hypertension with particular perioperative features.
| Original language | English |
|---|---|
| Pages (from-to) | 1615-1622 |
| Number of pages | 8 |
| Journal | Acta Neurochirurgica |
| Volume | 156 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 2014 |
Bibliographical note
Funding Information:A consensus conference was held in Milan on October 5, 2013, bringing together neurosurgeons and intensivists with recognized expertise in the treatment of TBI. The event was organized by the Italian Neurosurgical Society (SINch), sponsored by the European Association of Neurological Surgeons (EANS), and financially supported by Codman (a division of Ethicon Ltd.), with an unconditional grant. The conference started with a presentation of the BEST TRIP trial [] by the first author (RC), who also reported on follow-up conferences and meetings. Four topics were selected and addressed in pro-con presentations focusing on indications for ICP monitoring in: 1) diffuse brain injury, 2) cerebral contusions, 3) secondary DC, and 4) after evacuation of intracranial traumatic hematomas. The participants were asked to elaborate on the existing published evidence (without a systematic review) and their personal clinical experience. Each presentation was followed by short questions by the audience. The participants divided into small groups, and then examined the data presented in the pro-con presentations and summarized key points to be discussed by the assembly. Based on the presentations and discussions of the conference, drafts were circulated among the attendants by two authors (FS and NS). After remarks and further contributions had been collected, a final document was approved by the participants.
Funding Information:
We gratefully acknowledge the financial support by Codman (a division of Ethicon Ltd.)
Funding
A consensus conference was held in Milan on October 5, 2013, bringing together neurosurgeons and intensivists with recognized expertise in the treatment of TBI. The event was organized by the Italian Neurosurgical Society (SINch), sponsored by the European Association of Neurological Surgeons (EANS), and financially supported by Codman (a division of Ethicon Ltd.), with an unconditional grant. The conference started with a presentation of the BEST TRIP trial [] by the first author (RC), who also reported on follow-up conferences and meetings. Four topics were selected and addressed in pro-con presentations focusing on indications for ICP monitoring in: 1) diffuse brain injury, 2) cerebral contusions, 3) secondary DC, and 4) after evacuation of intracranial traumatic hematomas. The participants were asked to elaborate on the existing published evidence (without a systematic review) and their personal clinical experience. Each presentation was followed by short questions by the audience. The participants divided into small groups, and then examined the data presented in the pro-con presentations and summarized key points to be discussed by the assembly. Based on the presentations and discussions of the conference, drafts were circulated among the attendants by two authors (FS and NS). After remarks and further contributions had been collected, a final document was approved by the participants. We gratefully acknowledge the financial support by Codman (a division of Ethicon Ltd.)
| Funders | Funder number |
|---|---|
| Ethicon Ltd. | |
| European Association of Neurological Surgeons | |
| Italian Neurosurgical Society | |
| SINch | |
| Medical Research Council | G1002277, G0601025 |
| National Institute for Health Research | |
| Royal College of Surgeons of England |
Keywords
- Intracranial pressure
- Management
- Monitoring
- Traumatic brain injury