Escalation therapy in severe traumatic brain injury: how long is intracranial pressure monitoring necessary?
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REVIEW
Escalation therapy in severe traumatic brain injury: how long is intracranial pressure monitoring necessary? Pasquale Anania 1 & Denise Battaglini 2,3 & John P. Miller 4 & Alberto Balestrino 1 & Alessandro Prior 1 & Alessandro D’Andrea 1 & Filippo Badaloni 5 & Paolo Pelosi 2,6 & Chiara Robba 2,6 & Gianluigi Zona 1,7 & Pietro Fiaschi 1,7 Received: 11 May 2020 / Revised: 29 September 2020 / Accepted: 11 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Traumatic brain injury frequently causes an elevation of intracranial pressure (ICP) that could lead to reduction of cerebral perfusion pressure and cause brain ischemia. Invasive ICP monitoring is recommended by international guidelines, in order to reduce the incidence of secondary brain injury; although rare, the complications related to ICP probes could be dependent on the duration of monitoring. The aim of this manuscript is to clarify the appropriate timing for removal and management of invasive ICP monitoring, in order to reduce the risk of related complications and guarantee adequate cerebral autoregulatory control. There is no universal consensus concerning the duration of invasive ICP monitoring and its related complications, although the pertinent literature seems to show that the longer is the monitoring maintenance, the higher is the risk of technical issues. Besides, upon 72 h of normal ICP values or less than 72 h if the first computed tomography scan is normal (none or minimal signs of injury) and the neurological exam is available (allowing to observe variations and possible occurrence of new-onset pathological response), the removal of invasive ICP monitoring can be justified. The availability of non-invasive monitoring systems should be considered to follow up patients’ clinical course after invasive ICP probe removal or for substituting the invasive monitoring in case of contraindication to its placement. Recently, optic nerve sheath diameter and straight sinus systolic flow velocity evaluation through ultrasound methods showed a good correlation with ICP values, demonstrating their potential role in place of invasive monitoring or in the early weaning phase from the invasive ICP monitoring. Keywords TBI . Brain injury . ICP . Monitoring . Duration . Weaning
Introduction * Pasquale Anania [email protected] 1
Department of Neurosurgery, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
2
Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
3
Department of Medicine, University of Barcelona, Barcelona, Spain
4
Louisiana State University, Health Sciences University, New Orleans, LA, USA
5
Division of Neurosurgery, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
6
Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
7
Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal And Children (DINOGMI), University of
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