Intracranial Pressure Monitoring

Published on 22/03/2015 by admin

Filed under Critical Care Medicine

Last modified 22/03/2015

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W20 Intracranial Pressure Monitoring

Fabio S. Taccone, Sarice L. Bassin, Thomas P. Bleck, Jean-Louis Vincent

image Before Procedure

Indications

• Common:

• Traumatic brain injury (TBI)
• Subarachnoid hemorrhage
• Intracranial hemorrhage (ICH)
• Acute liver failure
• Hydrocephalus

• Uncommon:

• Meningitis/encephalitis/brain abscess
• Pseudotumor cerebri
• Postoperative

Contraindications

• Absolute:

• Anticoagulation
• Known bleeding diathesis

• Relative:

• Scalp infection
• Lack of specialized healthcare personnel

Equipment

• Flexible catheter or fiberoptic transducer
• Surgical scalpel
• Spinal needle
• Neurosurgical drill/saw
• Surgical scissors
• Retractors
• 14-gauge catheter

image Anatomy

For brain monitoring, the entry point is located in the superiorly directed midpupillary line, 3 cm lateral to the sagittal suture and 2 cm anterior to the coronal suture on the right (frontal approach). This is the most commonly chosen site because it sits anterior to the motor strip, is lateral to both the superior sagittal sinus and the large bridging veins, and is on the nondominant hemisphere in most patients. If using a posterior approach, the entry point is 6 cm from the inion and 3 cm lateral to the midline. For lumbar monitoring, the L3-4 space is preferred.

There are four main ways to monitor ICP:

1 Using an external flexible catheter inserted into the lateral cerebral ventricles (ventriculostomy)—the gold standard method
2 Using a catheter (fluid-coupled) or fiberoptic transducer (fluid-uncoupled) placed into the brain parenchyma (intraparenchymal catheter)
3 Using a screw or bolt placed through the skull into the subarachnoid space
4 Using a sensor positioned in the epidural/subdural space beneath the skull.

A lumbar drain can also be used to measure ICP and control CSF outflow if zeroed at the level of the third ventricle.

image Procedure

• Ventriculostomy:

• Place the patient in supine position with head of the bed elevated to approximately 20 degrees.
• Shave areas (frontal or posterior) bilaterally.
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