|
|||||
|
|
Clinical applications of intracranial pressure monitoring in traumatic brain injury |
|
| Authors: | Nino Stocchetti Edoardo Picetti Maurizio Berardino Andràs Buki Randall M. Chesnut Kostas N. Fountas Peter Horn Peter J. Hutchinson Corrado Iaccarino Angelos G. Kolias Lars-Owe Koskinen Nicola Latronico Andrews I. R. Maas Jean-François Payen Guy Rosenthal Juan Sahuquillo Stefano Signoretti Jean F. Soustiel Franco Servadei |
| Affiliation: | 1. Department of Physiopathology and Transplant, Milan University, Neuro ICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy 2. Division of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy 3. Anesthesia and ICU, Orthopedic and Trauma Hospital, AOU Città della Salute e della Scienza, Turin, Italy 4. Department of Neurosurgery, University of Pécs and Clinical Neuroscience Image Center of Hungarian Academy of Sciences (HAS), Pécs, Hungary 5. Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA 6. Department of Orthopaedic Surgery, University of Washington School of Medicine, Seattle, WA, USA 7. University of Washington School of Global Health, Seattle, WA, USA 8. Department of Neurosurgery School of Medicine, University of Thessaly, Larissa, Greece 9. Department of Neurosurgery, Dr. Horst Schmidt Klinik (HSK), Wiesbaden, Germany 10. Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital & University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK 11. Division of Neurotraumatology-Neurosurgery, Azienda Ospedaliero-Universitaria di Parma, ASMN-IRCCS Reggio Emilia, Parma, Reggio Emilia, Italy 12. Department of Neurosurgery, Ume? University Hospital, Ume?, Sweden 13. Department of Anesthesia and Critical Care Medicine, University of Brescia at Spedali Civili, Brescia, Italy 14. Department of Neurosurgery, University Hospital Antwerp, Antwerp, Belgium 15. P?le Anesthésie-Réanimation, CHU Grenoble, CS 10217, 38043, Grenoble Cedex 9, France 16. Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel 17. Department of Neurosurgery, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain 18. Division of Neurosurgery, Department of Head and Neck Surgery, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy 19. Department of Neurosurgery, Galilee Medical Center, Faculty of Medicine, Bar Ilan University, Naharia, Israel |
| Abstract: | BackgroundIntracranial 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.MethodsA 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 conclusionsThe 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. |
| Keywords: | |
| 本文献已被 SpringerLink 等数据库收录！ | |