Associations between intracranial pressure thresholds and multimodal monitoring in acute traumatic neural injury: a scoping review

Stein, Kevin Y.; Amenta, Fiorella; Gomez, Alwyn; Froese, Logan; Sainbhi, Amanjyot Singh; Vakitbilir, Nuray; Marquez, Izabella; Zeiler, Frederick A.

doi:10.1007/s00701-023-05587-6

Cited by 2 publications

(2 citation statements)

References 51 publications

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“… 20 A recent systematic review by our group found that there is very limited literature that demonstrates direct statistical associations between such modalities and ICP above/below guideline-defined thresholds. 86 …”

Section: Association Between Intracranial Pressure Control and Multi-...mentioning

confidence: 99%

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Intracranial Pressure Monitoring and Treatment Thresholds in Acute Neural Injury: A Narrative Review of the Historical Achievements, Current State, and Future Perspectives

Stein

Froese

Gomez

et al. 2023

Neurotrauma Reports

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Since its introduction in the 1960s, intracranial pressure (ICP) monitoring has become an indispensable tool in neurocritical care practice and a key component of the management of moderate/severe traumatic brain injury (TBI). The primary utility of ICP monitoring is to guide therapeutic interventions aimed at maintaining physiological ICP and preventing intracranial hypertension. The rationale for such ICP maintenance is to prevent secondary brain injury arising from brain herniation and inadequate cerebral blood flow. There exists a large body of evidence indicating that elevated ICP is associated with mortality and that aggressive ICP control protocols improve outcomes in severe TBI patients. Therefore, current management guidelines recommend a cerebral perfusion pressure (CPP) target range of 60–70 mm Hg and an ICP threshold of >20 or >22 mm Hg, beyond which therapeutic intervention should be initiated. Though our ability to achieve these thresholds has drastically improved over the past decades, there has been little to no change in the mortality and morbidity associated with moderate-severe TBI. This is a result of the “one treatment fits all” dogma of current guideline-based care that fails to take individual phenotype into account. The way forward in moderate-severe TBI care is through the development of continuously derived individualized ICP thresholds. This narrative review covers the topic of ICP monitoring in TBI care, including historical context/achievements, current monitoring technologies and indications, treatment methods, associations with patient outcome and multi-modal cerebral physiology, present controversies surrounding treatment thresholds, and future perspectives on personalized approaches to ICP-directed therapy.

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Section: Association Between Intracranial Pressure Control and Multi-...mentioning

confidence: 99%

“… 92 No studies that demonstrated an objective association between ICP above/below threshold and a metric of either electrophysiology or cerebral metabolism were found in the systematic review. 86 …”

Section: Association Between Intracranial Pressure Control and Multi-...mentioning

confidence: 99%

Intracranial Pressure Monitoring and Treatment Thresholds in Acute Neural Injury: A Narrative Review of the Historical Achievements, Current State, and Future Perspectives

Stein

Froese

Gomez

et al. 2023

Neurotrauma Reports

Self Cite

View full text Add to dashboard Cite

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Associations Between Intracranial Pressure Extremes and Continuous Metrics of Cerebrovascular Pressure Reactivity in Acute Traumatic Neural Injury: A Scoping Review

Stein,

Amenta,

Froese

et al. 2024

Neurotrauma Reports

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Associations between intracranial pressure thresholds and multimodal monitoring in acute traumatic neural injury: a scoping review

Cited by 2 publications

References 51 publications

Intracranial Pressure Monitoring and Treatment Thresholds in Acute Neural Injury: A Narrative Review of the Historical Achievements, Current State, and Future Perspectives

Intracranial Pressure Monitoring and Treatment Thresholds in Acute Neural Injury: A Narrative Review of the Historical Achievements, Current State, and Future Perspectives

Associations Between Intracranial Pressure Extremes and Continuous Metrics of Cerebrovascular Pressure Reactivity in Acute Traumatic Neural Injury: A Scoping Review

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