Abstract
A mainstay of the modern management of severe traumatic brain injury is avoidance of secondary injury by optimizing intracranial and cerebral perfusion pressures. While many studies support the role of treatment of intracranial pressures (ICPs) above 20–22 mmHg, there is little consensus regarding the choice of external ventricular drain versus intraparenchymal monitor or the utility of multimodal monitoring, most notably brain tissue oxygen monitors. An external ventricular drain allows for drainage of cerebral spinal fluid in addition to measurement of intracranial pressures but is associated with greater difficulty in placement and higher complication rates. Intraparenchymal monitors are more easily inserted and have fewer complications but are without intrinsic therapeutic function and are associated with higher intracranial pressures and rates of surgical decompressions. The addition of a brain tissue oxygen monitor may prove to be an important reference that puts in context intracranial pressures and cerebral perfusion pressures. More recent technologies allow concomitant drainage of cerebral spinal fluid while monitoring intracranial pressures. Future technologies will incorporate ICP, brain tissue oxygenation, and brain temperature monitoring without the need for multiple device insertion.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Lundberg N. Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand Suppl. 1960;36(149):1–193.
Narayan RK, Kishore PR, Becker DP, Ward JD, Enas GG, Greenberg RP, et al. Intracranial pressure: to monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg. 1982;56(5):650–9.
Juul N, Morris GF, Marshall SB, Marshall LF. Intracranial hypertension and cerebral perfusion pressure: influence on neurological deterioration and outcome in severe head injury. The executive committee of the international selfotel trial. J Neurosurg. 2000;92(1):1–6.
Murray GD, Butcher I, McHugh GS, Lu J, Mushkudiani NA, Maas AI, et al. Multivariable prognostic analysis in traumatic brain injury: results from the impact study. J Neurotrauma. 2007;24(2):329–37.
Balestreri M, Czosnyka M, Hutchinson P, Steiner LA, Hiler M, Smielewski P, et al. Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury. Neurocrit Care. 2006;4(1):8–13.
Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80(1):6–15.
Mehta A, Kochanek PM, Tyler-Kabara E, Adelson PD, Wisniewski SR, Berger RP, et al. Relationship of intracranial pressure and cerebral perfusion pressure with outcome in young children after severe traumatic brain injury. Dev Neurosci. 2010;32(5–6):413–9.
Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012;367(26):2471–81.
Cremer OL, van Dijk GW, van Wensen E, Brekelmans GJ, Moons KG, Leenen LP, et al. Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. Crit Care Med. 2005;33(10):2207–13.
Shafi S, Diaz-Arrastia R, Madden C, Gentilello L. Intracranial pressure monitoring in brain-injured patients is associated with worsening of survival. J Trauma. 2008;64(2):335–40.
Farahvar A, Gerber LM, Chiu YL, Carney N, Hartl R, Ghajar J. Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring. J Neurosurg. 2012;117(4):729–34.
Stein SC, Georgoff P, Meghan S, Mirza KL, El Falaky OM. Relationship of aggressive monitoring and treatment to improved outcomes in severe traumatic brain injury. J Neurosurg. 2010;112(5):1105–12.
Yuan Q, Wu X, Sun Y, Yu J, Li Z, Du Z, et al. Impact of intracranial pressure monitoring on mortality in patients with traumatic brain injury: a systematic review and meta-analysis. J Neurosurg. 2015;122(3):574–87.
Han J, Yang S, Zhang C, Zhao M, Li A. Impact of intracranial pressure monitoring on prognosis of patients with severe traumatic brain injury: a prisma systematic review and meta-analysis. Medicine (Baltimore). 2016;95(7):e2827.
Alali AS, Fowler RA, Mainprize TG, Scales DC, Kiss A, de Mestral C, et al. Intracranial pressure monitoring in severe traumatic brain injury: results from the American College of Surgeons Trauma Quality Improvement Program. J Neurotrauma. 2013;30(20):1737–46.
Chesnut RM, Bleck TP, Citerio G, Classen J, Cooper DJ, Coplin WM, et al. A consensus-based interpretation of the benchmark evidence from south American trials: treatment of intracranial pressure trial. J Neurotrauma [Research Support, Non-US Gov’t]. 2015;32(22):1722–4.
Sahjpaul R, Girotti M. Intracranial pressure monitoring in severe traumatic brain injury—results of a Canadian survey. Can J Neurol Sci. 2000;27(2):143–7.
Lingsma HF, Roozenbeek B, Perel P, Roberts I, Maas AI, Steyerberg EW. Between-centre differences and treatment effects in randomized controlled trials: a case study in traumatic brain injury. Trials. 2011;12:201.
Kasotakis G, Michailidou M, Bramos A, Chang Y, Velmahos G, Alam H, et al. Intraparenchymal vs extracranial ventricular drain intracranial pressure monitors in traumatic brain injury: less is more? J Am Coll Surg. 2012;214(6):950–7.
Sadaka F, Kasal J, Lakshmanan R, Palagiri A. Placement of intracranial pressure monitors by neurointensivists: case series and a systematic review. Brain Inj. 2013;27(5):600–4.
Newcombe VF, Hawkes RC, Harding SG, Willcox R, Brock S, Hutchinson PJ, et al. Potential heating caused by intraparenchymal intracranial pressure transducers in a 3-tesla magnetic resonance imaging system using a body radiofrequency resonator: assessment of the codman microsensor transducer. J Neurosurg. 2008;109(1):159–64.
Saladino A, White JB, Wijdicks EF, Lanzino G. Malplacement of ventricular catheters by neurosurgeons: a single institution experience. Neurocrit Care. 2009;10(2):248–52.
Guyot LL, Dowling C, Diaz FG, Michael DB. Cerebral monitoring devices: analysis of complications. Acta Neurochir Suppl. 1998;71:47–9.
Zabramski JM, Whiting D, Darouiche RO, Horner TG, Olson J, Robertson C, et al. Efficacy of antimicrobial-impregnated external ventricular drain catheters: a prospective, randomized, controlled trial. J Neurosurg. 2003;98(4):725–30.
Miller C, Tummala RP. Risk factors for hemorrhage associated with external ventricular drain placement and removal. J Neurosurg. 2017;126(1):289–97.
Liu H, Wang W, Cheng F, Yuan Q, Yang J, Hu J, et al. External ventricular drains versus intraparenchymal intracranial pressure monitors in traumatic brain injury: a prospective observational study. World Neurosurg. 2015;83(5):794–800.
Nwachuku EL, Puccio AM, Fetzick A, Scruggs B, Chang YF, Shutter LA, et al. Intermittent versus continuous cerebrospinal fluid drainage management in adult severe traumatic brain injury: assessment of intracranial pressure burden. Neurocrit Care. 2014;20(1):49–53.
Shore PM, Thomas NJ, Clark RS, Adelson PD, Wisniewski SR, Janesko KL, et al. Continuous versus intermittent cerebrospinal fluid drainage after severe traumatic brain injury in children: effect on biochemical markers. J Neurotrauma. 2004;21(9):1113–22.
Gopinath SP, Robertson CS, Contant CF, Hayes C, Feldman Z, Narayan RK, et al. Jugular venous desaturation and outcome after head injury. J Neurol Neurosurg Psychiatry. 1994;57(6):717–23.
Le Roux PD, Newell DW, Lam AM, Grady MS, Winn HR. Cerebral arteriovenous oxygen difference: a predictor of cerebral infarction and outcome in patients with severe head injury. J Neurosurg. 1997;87(1):1–8.
Menon DK, Coles JP, Gupta AK, Fryer TD, Smielewski P, Chatfield DA, et al. Diffusion limited oxygen delivery following head injury. Crit Care Med. 2004;32(6):1384–90.
Vespa PM, O’Phelan K, McArthur D, Miller C, Eliseo M, Hirt D, et al. Pericontusional brain tissue exhibits persistent elevation of lactate/pyruvate ratio independent of cerebral perfusion pressure. Crit Care Med. 2007;35(4):1153–60.
Bardt TF, Unterberg AW, Hartl R, Kiening KL, Schneider GH, Lanksch WR. Monitoring of brain tissue po2 in traumatic brain injury: effect of cerebral hypoxia on outcome. Acta Neurochir Suppl. 1998;71:153–6.
Kiening KL, Hartl R, Unterberg AW, Schneider GH, Bardt T, Lanksch WR. Brain tissue po2-monitoring in comatose patients: implications for therapy. Neurol Res. 1997;19(3):233–40.
Cruz J. The first decade of continuous monitoring of jugular bulb oxyhemoglobinsaturation: management strategies and clinical outcome. Crit Care Med. 1998;26(2):344–51.
Valadka AB, Gopinath SP, Contant CF, Uzura M, Robertson CS. Relationship of brain tissue po2 to outcome after severe head injury. Crit Care Med. 1998;26(9):1576–81.
Stiefel MF, Spiotta A, Gracias VH, Garuffe AM, Guillamondegui O, Maloney-Wilensky E, et al. Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring. J Neurosurg. 2005;103(5):805–11.
Spiotta AM, Stiefel MF, Gracias VH, Garuffe AM, Kofke WA, Maloney-Wilensky E, et al. Brain tissue oxygen-directed management and outcome in patients with severe traumatic brain injury. J Neurosurg. 2010;113(3):571–80.
Narotam PK, Morrison JF, Nathoo N. Brain tissue oxygen monitoring in traumatic brain injury and major trauma: outcome analysis of a brain tissue oxygen-directed therapy. J Neurosurg. 2009;111(4):672–82.
Green JA, Pellegrini DC, Vanderkolk WE, Figueroa BE, Eriksson EA. Goal directed brain tissue oxygen monitoring versus conventional management in traumatic brain injury: an analysis of in hospital recovery. Neurocrit Care. 2013;18(1):20–5.
Martini RP, Deem S, Yanez ND, Chesnut RM, Weiss NS, Daniel S, et al. Management guided by brain tissue oxygen monitoring and outcome following severe traumatic brain injury. J Neurosurg. 2009;111(4):644–9.
Contant CF, Valadka AB, Gopinath SP, Hannay HJ, Robertson CS. Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury. J Neurosurg. 2001;95(4):560–8.
Cruz J. Adverse effects of pentobarbital on cerebral venous oxygenation of comatose patients with acute traumatic brain swelling: relationship to outcome. J Neurosurg. 1996;85(5):758–61.
Rosenthal G, Hemphill JC 3rd, Sorani M, Martin C, Morabito D, Obrist WD, et al. Brain tissue oxygen tension is more indicative of oxygen diffusion than oxygen delivery and metabolism in patients with traumatic brain injury. Crit Care Med. 2008;36(6):1917–24.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Ricks, C.B., Okonkwo, D.O. (2018). Choice of Intracranial Pressure Monitoring Modality: Parenchymal Monitor vs. Parenchymal Monitor with Brain Tissue Oxygen Monitor vs. External Ventricular Drain. In: Timmons, S. (eds) Controversies in Severe Traumatic Brain Injury Management. Springer, Cham. https://doi.org/10.1007/978-3-319-89477-5_4
Download citation
DOI: https://doi.org/10.1007/978-3-319-89477-5_4
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-89476-8
Online ISBN: 978-3-319-89477-5
eBook Packages: MedicineMedicine (R0)