Intracranial Pressure Values Are Highly Variable After Cerebral Spinal Fluid Drainage

Abstract

Intracranial pressure (ICP) is often obtained via external ventricular drain (EVD) placement and is discussed as a key vital sign in neuroscience. Nurses are most often delegated the task of observing, adjudicating, and documenting ICP. Cerebrospinal fluid drainage requires that the transducer connected to the EVD is open to drain, prohibiting ICP monitoring. There are no recent data to support an evidence-based standard for the period an ICP waveform should be observed, after the EVD is clamped, to be able to adjudicate a value that represents the patient's status. Therefore, the purpose of this study is to determine the optimal period for which an EVD should be closed to obtain an accurate ICP value. In a sample of 30 subjects who received continuous ICP monitoring for 15 minutes, there was no universal pattern to ICP after clamping an EVD. The conditional probability of observing a patient's highest ICP, if ICP is observed for 5 minutes, is 0.0181. The conditional probability increased to 0.0402 if ICP is observed for 10 minutes. There were no instances of ICP elevation requiring intervention. The results suggest that at least 5 minutes of ICP monitoring is safe and is required to provide an ICP value that reflects true ICP.

Differentiate the Source and Site of Intracranial Pressure Measurements Using More Precise Nomenclature

“…Drift or zero loss (zero drift) has been discussed primarily for IPM; however, the most recent summary of the literature supports that mean drift is less than 1 mmHg [22]. Similarly, recent articles find that measurement techniques and anatomical reference points are not standardized and may contribute to measurement variability [16,17,23]. The importance of delineating between measurement techniques is a critical first step toward identifying the optimal measurement approach.…”

Service of nursing in intracranial pressure monitoring in patients neurocríticos / Assistência de enfermagem na monitorização da pressão intracraniana em pacientes neurocríticos

“…1 This is often obtained by placing an external ventricular drain in one of the lateral ventricles of the brain area. 1,2 This is characterized as a key vital sign in neuroscience and is the result of the balance of three components: cerebrospinal fluid, blood, and cerebral parenchyma. Its normal pressure ranges from 5 to 15 mmHg 1 or up to 20 cmH 2 O.…”

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“…Its concept is intracranial pressure (ICP) as the hydrostatic pressure of the cerebrospinal fluid (CSF) that surrounds the brain neural tissue and vasculature into the cavity crania. 1 This is often achieved through the placement of an external ventricular drain (EVD or ventriculostomy), in a region of the lateral ventricles cerebral 1,2 results from the balance of three components: cerebrospinal fluid, blood, and brain parenchyma, which makes a key vital sign in neuroscience. Its normal pressure ranges from 5 to 15 mmHg, or even 20 cmH2O.…”