Skip to main content

Monitoring and Managing Raised Intracranial Pressure after Traumatic Brain Injury

  • Conference paper
Intensive Care Medicine

Abstract

The primary aim of the intensive care management of traumatic brain injury (TBI) is to prevent and treat secondary brain injury using a multi-faceted neuroprotective strategy to maintain cerebral perfusion in order to meet the brain’s metabolic demands. Raised intracranial pressure (ICP) is an important cause of secondary brain injury and associated with adverse outcome after TBI. It can be related to intracranial mass lesions, contusional injuries, vascular engorgement, and brain edema. The prevention and control of raised ICP, and maintenance of cerebral perfusion pressure (CPP), are fundamental therapeutic goals after TBI. Despite the absence of class-1 studies, ICP monitoring has developed a prominent role in the management of severe TBI and is recommended by international consensus guidance. It is generally accepted as a relatively low-risk, high-yield, and value for money intervention, although there are wide variations in its application.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Smith M (2008) Monitoring intracranial pressure in traumatic brain injury. Anesth Analg 106: 240–248

    Article  PubMed  Google Scholar 

  2. The Brain Trauma Foundation, The American Association of Neurological Surgeons, The Joint Section on Neurotrauma and Critical Care (2007) J Neurotrauma 24:S1–S106

    Article  Google Scholar 

  3. Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ (2002) Management of severe head injury: institutional variations in care and effect on outcome. Crit Care Med 30: 1870–1876

    Article  PubMed  Google Scholar 

  4. Stocchetti N, Penny KI, Dearden M, et al (2001) Intensive care management of head-injured patients in Europe: a survey from the European brain injury consortium. Intensive Care Med 27: 400–406

    Article  CAS  PubMed  Google Scholar 

  5. Sahjpaul R, Girotti M (2000) Intracranial pressure monitoring in severe traumatic brain injury — results of a Canadian survey. Can J Neurol Sci 27: 143–147

    CAS  PubMed  Google Scholar 

  6. Balestreri M, Czosnyka M, Hutchinson P, et al (2006) Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury. Neurocrit Care 4: 8–13

    Article  PubMed  Google Scholar 

  7. Smith M (2004) Neurocritical care: has it come of age? Br J Anaesth 93: 753–755

    Article  CAS  PubMed  Google Scholar 

  8. Helmy A, Vizcaychipi M, Gupta AK (2007) Traumatic brain injury: intensive care management. Br J Anaesth 99: 32–42

    Article  CAS  PubMed  Google Scholar 

  9. Citerio G, Cormio M (2003) Sedation in neurointensive care: advances in understanding and practice. Curr Opin Crit Care 9: 120–126

    Article  PubMed  Google Scholar 

  10. Coles JP, Fryer TD, Coleman MR, et al (2007) Hyperventilation following head injury: effect on ischemic burden and cerebral oxidative metabolism. Crit Care Med 35: 568–578

    Article  CAS  PubMed  Google Scholar 

  11. Tisdall MM, Smith M (2007) Multimodal monitoring in traumatic brain injury: current status and future directions. Br J Anaesth 99: 61–67

    Article  CAS  PubMed  Google Scholar 

  12. Wakai A, Roberts I, Schierhout G (2007) Mannitol for acute traumatic brain injury. Cochrane Database Syst Rev CD001049

    Google Scholar 

  13. Himmelseher S (2007) Hypertonic saline solutions for treatment of intracranial hypertension. Curr Opin Anaesthesiol 20: 414–426

    Article  PubMed  Google Scholar 

  14. White H, Cook D, Venkatesh B (2006) The use of hypertonic saline for treating intracranial hypertension after traumatic brain injury. Anesth Analg 102: 1836–1846

    Article  CAS  PubMed  Google Scholar 

  15. Clifton GL, Miller ER, Choi SC, et al (2001) Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 344: 556–563

    Article  CAS  PubMed  Google Scholar 

  16. Polderman KH, Ely EW, Badr AE, Girbes AR (2004) Induced hypothermia in traumatic brain injury: considering the conflicting results of meta-analyses and moving forward. Intensive Care Med 30: 1860–1864

    Article  PubMed  Google Scholar 

  17. Roberts I (2000) Barbiturates for acute traumatic brain injury. Cochrane Database Syst Rev CD000033

    Google Scholar 

  18. Hutchinson PJ, Kirkpatrick PJ (2004) Decompressive craniectomy in head injury. Curr Opin Crit Care 10: 101–104

    Article  CAS  PubMed  Google Scholar 

  19. Resnick DK, Marion DW, Carlier P (1997) Outcome analysis of patients with severe head injuries and prolonged intracranial hypertension. J Trauma 42: 1108–1111

    Article  CAS  PubMed  Google Scholar 

  20. Treggiari MM, Schutz N, Yanez ND, Romand JA (2007) Role of intracranial pressure values and patterns in predicting outcome in traumatic brain injury: a systematic review. Neurocrit Care 6: 104–112

    Article  PubMed  Google Scholar 

  21. Stiefel MF, Udoetuk JD, Spiotta AM, et al (2006) Conventional neurocritical care and cerebral oxygenation after traumatic brain injury. J Neurosurg 105: 568–575

    Article  PubMed  Google Scholar 

  22. Stiefel MF, Spiotta A, Gracias VH, et al (2005) Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring. J Neurosurg 103: 805–811

    Article  PubMed  Google Scholar 

  23. Lane PL, Skoretz TG, Doig G, Girotti MJ (2000) Intracranial pressure monitoring and outcomes after traumatic brain injury. Can J Surg 43: 442–448

    CAS  PubMed  Google Scholar 

  24. Cremer OL, van Dijk GW, van Wensen E, et al (2005) Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. Crit Care Med 33: 2207–2213

    Article  PubMed  Google Scholar 

  25. Mauritz W, Steltzer H, Bauer P, Dolanski-Aghamanoukjan L, Metnitz P (2008) Monitoring of intracranial pressure in patients with severe traumatic brain injury: an Austrian prospective multicenter study. Intensive Care Med 34: 1208–1215

    Article  PubMed  Google Scholar 

  26. Robertson CS, Valadka AB, Hannay HJ, et al (1999) Prevention of secondary ischemic insults after severe head injury. Crit Care Med 27: 2086–2095

    Article  CAS  PubMed  Google Scholar 

  27. Rosner MJ, Rosner SD, Johnson AH (1995) Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg 83: 949–962

    Article  CAS  PubMed  Google Scholar 

  28. Steiner LA, Coles JP, Johnston AJ, et al (2003) Responses of posttraumatic pericontusional cerebral blood flow and blood volume to an increase in cerebral perfusion pressure. J Cereb Blood Flow Metab 23: 1371–1377

    Article  PubMed  Google Scholar 

  29. Cremer OL, van Dijk GW, Amelink GJ, de Smet AM, Moons KG, Kalkman CJ (2004) Cerebral hemodynamic responses to blood pressure manipulation in severely head-injured patients in the presence or absence of intracranial hypertension. Anesth Analg 99: 1211–1217

    Article  PubMed  Google Scholar 

  30. Belli A, Sen J, Petzold A, Russo S, Kitchen N, Smith M (2008) Metabolic failure precedes intracranial pressure rises in traumatic brain injury: a microdialysis study. Acta Neurochir (Wien) 150: 461–469

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Smith, M. (2009). Monitoring and Managing Raised Intracranial Pressure after Traumatic Brain Injury. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92278-2_73

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-92278-2_73

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-92277-5

  • Online ISBN: 978-0-387-92278-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics