Clinical applications of intracranial pressure monitoring in traumatic brain injury
Clinical applications of intracranial pressure monitoring in traumatic brain injury
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DOI：
10.1007/s00701-014-2127-4
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发表时间：
2014-08-01
影响因子：
2.4
通讯作者：
Servadei, Franco
中科院分区：
文献类型：
--
作者：
Stocchetti, Nino;Picetti, Edoardo;Servadei, Franco
几十年来，颅内压（ICP）监测一直是创伤性脑损伤（TBI）管理的基石。然而，近年来，有几份报告对它的用处提出了质疑。一组神经外科医生和神经重症监护医生开会公开讨论ICP在严重成人TBI中的实际应用，并达成共识。2013年10月5日在米兰举行了一次共识会议，汇集了在TBI治疗方面具有公认专业知识的神经外科医生和重症监护医生。选择了四个主题并在正反两方面进行了讨论：1）弥漫性脑损伤的ICP适应症，2）脑挫伤，3）二次去骨瓣减压术（DC），4）颅内创伤性血肿清除后。参与者被要求详细说明现有的已发表证据（没有系统性综述）和他们的个人临床经验。根据会议的发言和讨论，向与会者分发了一些草案。在收集了评论和进一步的贡献后，与会者批准了最终文件。该小组提出了以下建议：1）在昏迷的TBI患者中，如果计算机断层扫描（CT）扫描正常，则没有ICP监测的指征;（二）颅内压监测适用于伴有脑挫伤的昏迷TBI患者，在这些患者中，中断镇静以检查神经系统状态是危险的，临床检查并不完全可靠。探头应定位在较大挫伤的一侧; 3）通常建议在二次DC后进行ICP监测，以评估DC在ICP控制方面的有效性并指导进一步治疗; 4）对于具有特定围手术期特征的颅内高压风险增加的可挽救患者，应考虑在急性幕上颅内血肿清除后进行ICP监测。
Intracranial pressure (ICP) monitoring has been for decades a cornerstone of traumatic brain injury (TBI) management. Nevertheless, in recent years, its usefulness has been questioned in several reports. A group of neurosurgeons and neurointensivists met to openly discuss, and provide consensus on, practical applications of ICP in severe adult TBI.A consensus conference was held in Milan on October 5, 2013, putting together neurosurgeons and intensivists with recognized expertise in treatment of TBI. Four topics have been selected and addressed in pro-con presentations: 1) ICP indications in diffuse brain injury, 2) cerebral contusions, 3) secondary decompressive craniectomy (DC), and 4) after evacuation of intracranial traumatic hematomas. The participants were asked to elaborate on the existing published evidence (without a systematic review) and their personal clinical experience. Based on the presentations and discussions of the conference, some drafts were circulated among the attendants. After remarks and further contributions were collected, a final document was approved by the participants.The group made the following recommendations: 1) in comatose TBI patients, in case of normal computed tomography (CT) scan, there is no indication for ICP monitoring; 2) ICP monitoring is indicated in comatose TBI patients with cerebral contusions in whom the interruption of sedation to check neurological status is dangerous and when the clinical examination is not completely reliable. The probe should be positioned on the side of the larger contusion; 3) ICP monitoring is generally recommended following a secondary DC in order to assess the effectiveness of DC in terms of ICP control and guide further therapy; 4) ICP monitoring after evacuation of an acute supratentorial intracranial hematoma should be considered for salvageable patients at increased risk of intracranial hypertension with particular perioperative features.