Management of Raised Intracranial Pressure
A central foundation of neurological intensive care has been the direct measurement of ICP in order to predict clinical deterioration and guide treatment. This is similar to using pulmonary capillary wedge pressure to manage congestive heart failure or haemodynamic shock. To virtually everyone's surprise, clinical trials have been unable to show clear value to pulmonary artery pressure measurements over clinical and X-ray evaluation. The approach of direct measurement of ICP originated in the studies of brain trauma conducted decades ago by Lundberg, Becker, and Marshall as summarised in a contemporary review. Lundberg et al showed that ICP could be measured for clinical purposes continuously and safely rather than intermittently by lumbar puncture. They used intraventricular catheters for this purpose and demonstrated that a patient's clinical state deteriorated at high pressures. The results from almost every subsequent study have suggested that this type of pressure monitoring helped to guide treatment, at least for traumatic brain injury.
To Be or Not to Be Monitored
A central foundation of neurological intensive care has been the direct measurement of ICP in order to predict clinical deterioration and guide treatment. This is similar to using pulmonary capillary wedge pressure to manage congestive heart failure or haemodynamic shock. To virtually everyone's surprise, clinical trials have been unable to show clear value to pulmonary artery pressure measurements over clinical and X-ray evaluation. The approach of direct measurement of ICP originated in the studies of brain trauma conducted decades ago by Lundberg, Becker, and Marshall as summarised in a contemporary review. Lundberg et al showed that ICP could be measured for clinical purposes continuously and safely rather than intermittently by lumbar puncture. They used intraventricular catheters for this purpose and demonstrated that a patient's clinical state deteriorated at high pressures. The results from almost every subsequent study have suggested that this type of pressure monitoring helped to guide treatment, at least for traumatic brain injury.