TABLE 2.
Factors Relevant to the Decision-Making Process in Deciding to Monitor ICP in TBI
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● The risks of monitor insertion and maintenance |
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● The suspicion that ICP is elevated |
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● The concern that the degree of suspected intracranial hypertension will restrict recovery if not actively managed |
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● The concern for neuroworsening if quantitative ICP is not known |
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● The prognostic value of knowing that intracranial hypertension is extreme/refractory to treatment as a sign of very severe primary disease |
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● The value of quantitative ICP in facilitating evaluation of treatment escalation (eg, tier 3 intervention) |
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● The risks of overtreating ICP (with and without quantitative ICP data) |
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● The value of quantitative ICP in |
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○ Guiding resuscitation (eg, CPP maintenance) |
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○ Calculating CPP and facilitating CPP-directed therapy |
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○ Enabling determination of a patient's autoregulatory status |
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○ Assisting in the understanding of other cranial monitors (pupillometry, PbtO2, etc.) |
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● The value of a quantitative monitor in providing an early warning system for potential neuroworsening in a busy or nonspecialist environment |
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● The value of knowing that ICP is NOT elevated |
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○ Allowing other nonurgent systemic surgeries to be performed early |
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○ Allowing other nonurgent cranial surgeries to be performed early |
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○ Facilitating treatment of systemic abnormalities (eg, proning for ARDS) |
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○ Facilitating extubation and transfer from ICU |
ARDS, adult respiratory distress syndrome; CPP, cerebral perfusion pressure; ICP, intracranial pressure; ICU, intensive care unit; PbtO2, brain tissue oxygen; TBI, traumatic brain injury.