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Does ICP monitoring make a difference in neurocritical care?

Published online by Cambridge University Press:  01 February 2008

O. L. Cremer
O. L. Cremer*
Affiliation:
University Medical Center, Department of Intensive Care, Utrecht, The Netherlands
*
Correspondence to: Olaf L. Cremer, Department of Intensive Care, University Medical Center Q04.2.313, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. E-mails: o.l.cremer@umcutrecht.nl, o.l.cremer@planet.nl; Tel: +31 87553261; Fax: +31 887555032
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Summary

Raised intracranial pressure and low cerebral perfusion pressure are associated with ischaemia and poor outcome after brain injury. Therefore, many management protocols target these variables. However, there are no randomized controlled trials that have demonstrated the effectiveness of intracranial pressure-guided care in severely head-injured patients. Observational studies of such therapy have yielded inconsistent results, ranging from decreased mortality to no effect or increased morbidity or mortality. A recent cohort study supports the notion that the possible benefits of intracranial pressure monitoring after traumatic brain injury are small – if present – and would exceed a number needed for the treatment of 16. Furthermore, intracranial pressure monitoring and aggressive management of intracranial pressure and cerebral perfusion pressure have been associated with increased lengths of stay in the neurocritical care unit, conceivable costs and possibly an increased rate of complications. Against this background, there is sufficient clinical equipoise to warrant an adequately powered randomized controlled trial to compare intracranial pressure-guided care with supportive critical care without intracranial pressure monitoring in patients with severe traumatic brain injury. However, the realization of such a trial is likely to be problematic for a number of reasons, not least of which the firmly held biases of many clinicians.

Keywords

HEAD INJURYINTRACRANIAL PRESSURE MONITORINGBLOOD PRESSURE, intracerebralOUTCOME

Information

Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue S42 , February 2008 , pp. 87 - 93
Copyright
Copyright © European Society of Anaesthesiology 2008

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