Hemorrhagic Complications of Intracranial Pressure Monitors in Children

Abstract

Intracranial pressure (ICP) monitoring plays a valuable role in the management of head injuries and other causes of raised ICP in the pediatric population. The purpose of this study was to investigate the incidence of hemorrhage after ICP monitor insertion, and to classify these complications in a clinically relevant manner. Hospital charts of 431 children (ages 0–16 years) admitted to a level I trauma center over a 2-year period were reviewed and 112 patients (134 insertions) who underwent intraparenchymal ICP monitoring were identified. The authors reviewed postoperative neuroradiological studies. One hundred and nineteen procedures were carried out without any hemorrhage (grade 0). After 10 insertions, a small punctate hemorrhage or localized subarachnoid hemorrhage occurred (grade 1). Three patients sustained an intracerebral hemorrhage that did not require evacuation or manifest as a new neurological deficit (grade 2). There were no hemorrhagic complications that necessitated evacuation or resulted in a noticeable change in the patient’s clinical condition (grade 3). We propose a new grading system for hemorrhage after ICP monitor insertion. We found a complication rate close to 10% in our pediatric patients. Fortunately, these hemorrhages were clinically silent and no neurosurgical intervention was necessary. However, grade 1 and grade 2 hemorrhages may manifest with a false reading of high ICP, and the long-term consequences of these complications are not known. Of note, only 23% of these complications were reflected in the patients charts, which may explain the low complication rates reported in other studies that did not analyze postoperative neuroradiological studies.

Does ICP monitoring make a difference in neurocritical care?

“…However, the reported incidences range from 0% to 15% in the literature [15,16]. Interestingly, in a recent study of 155 insertions with a 9.7% haemorrhage rate, complications occurred more frequently after ICP monitor placement in the operating theatre as compared to bedside procedures [17].…”

Sonographic Optic Nerve Sheath Diameter as an Estimate of Intracranial Pressure in Adult Trauma

“…Additionally, the ability to place an ICP monitor may be delayed because of the coagulopathy that often accompanies patients with severe injuries [7]. Moreover, the invasive manner of an intracranial pressure monitor carries several risks, including hemorrhage, infection, malposition, obstruction, and device malfunction [8][9][10][11][12][13][14][15].…”

Placement of External Ventricular Drains and Intracranial Pressure Monitors by Neurointensivists

“…External ventricular drainage (EVD) is an important diagnostic and therapeutic tool for the continuous management of intracranial pressure (ICP) and cerebrospinal fluid (CSF) analysis and drainage [1][2][3][4][5][6][7][8][9][10][11][12]. It can also function as a conduit for administration of various pharmacological agents into the intrathecal space.…”

“…Presence of obstructive hydrocephalus and high ICP can lead to significant morbidity and mortality. EVDs can reduce ICP by limiting obstructive hydrocephalus, thereby reducing morbidity and mortality [1][2][3][4][5][6][7][8][9][10][11].…”