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Intracranial Pressure Monitoring: Invasive versus Non-Invasive Methods-A Review.

Raboel PH, Bartek J, Andresen M, Bellander BM, Romner B - Crit Care Res Pract (2012)

Bottom Line: There are multiple techniques: invasive as well as noninvasive.The non-invasive techniques are without the invasive methods' risk of complication, but fail to measure ICP accurately enough to be used as routine alternatives to invasive measurement.We conclude that invasive measurement is currently the only option for accurate measurement of ICP.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark.

ABSTRACT
Monitoring of intracranial pressure (ICP) has been used for decades in the fields of neurosurgery and neurology. There are multiple techniques: invasive as well as noninvasive. This paper aims to provide an overview of the advantages and disadvantages of the most common and well-known methods as well as assess whether noninvasive techniques (transcranial Doppler, tympanic membrane displacement, optic nerve sheath diameter, CT scan/MRI and fundoscopy) can be used as reliable alternatives to the invasive techniques (ventriculostomy and microtransducers). Ventriculostomy is considered the gold standard in terms of accurate measurement of pressure, although microtransducers generally are just as accurate. Both invasive techniques are associated with a minor risk of complications such as hemorrhage and infection. Furthermore, zero drift is a problem with selected microtransducers. The non-invasive techniques are without the invasive methods' risk of complication, but fail to measure ICP accurately enough to be used as routine alternatives to invasive measurement. We conclude that invasive measurement is currently the only option for accurate measurement of ICP.

No MeSH data available.


Related in: MedlinePlus

Propagation of the cardiac pulse pressure signal.
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Related In: Results  -  Collection


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fig2: Propagation of the cardiac pulse pressure signal.

Mentions: Another pitfall in the clinical use of ICP monitoring is in determining the validity of the obtained pressure value. Access to a high-resolution view of the intracranial pressure waveform enables more accurate analysis of the obtained ICP as highlighted by the following examples. Electrostatic discharges may cause both rapid shifts of ICP as well as gradual drifts, which may escape the attention of the clinician [39]. Attention to the mean wave amplitude will show increasing amplitude at increasing ICP, while ICP shifts due to electrostatic discharges will not be accompanied by increasing mean wave amplitude. Furthermore, in performing basic checks of whether the ICP signal is truly representative of the intracranial pressure, the clinician should ensure that there is in fact an oscillating pressure curve with the progressively decreasing P1, P2, and P3 notches present, indicating propagation of the cardiac pulse pressure signal (Figure 2). Further information is found in the pulse pressure signal, with reversal of the P1 and P2 notches reflecting a state of disturbed autoregulation. A complete absence of a pressure curve may additionally be seen following craniectomy and in postoperative pneumencephalon.


Intracranial Pressure Monitoring: Invasive versus Non-Invasive Methods-A Review.

Raboel PH, Bartek J, Andresen M, Bellander BM, Romner B - Crit Care Res Pract (2012)

Propagation of the cardiac pulse pressure signal.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3376474&req=5

fig2: Propagation of the cardiac pulse pressure signal.
Mentions: Another pitfall in the clinical use of ICP monitoring is in determining the validity of the obtained pressure value. Access to a high-resolution view of the intracranial pressure waveform enables more accurate analysis of the obtained ICP as highlighted by the following examples. Electrostatic discharges may cause both rapid shifts of ICP as well as gradual drifts, which may escape the attention of the clinician [39]. Attention to the mean wave amplitude will show increasing amplitude at increasing ICP, while ICP shifts due to electrostatic discharges will not be accompanied by increasing mean wave amplitude. Furthermore, in performing basic checks of whether the ICP signal is truly representative of the intracranial pressure, the clinician should ensure that there is in fact an oscillating pressure curve with the progressively decreasing P1, P2, and P3 notches present, indicating propagation of the cardiac pulse pressure signal (Figure 2). Further information is found in the pulse pressure signal, with reversal of the P1 and P2 notches reflecting a state of disturbed autoregulation. A complete absence of a pressure curve may additionally be seen following craniectomy and in postoperative pneumencephalon.

Bottom Line: There are multiple techniques: invasive as well as noninvasive.The non-invasive techniques are without the invasive methods' risk of complication, but fail to measure ICP accurately enough to be used as routine alternatives to invasive measurement.We conclude that invasive measurement is currently the only option for accurate measurement of ICP.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark.

ABSTRACT
Monitoring of intracranial pressure (ICP) has been used for decades in the fields of neurosurgery and neurology. There are multiple techniques: invasive as well as noninvasive. This paper aims to provide an overview of the advantages and disadvantages of the most common and well-known methods as well as assess whether noninvasive techniques (transcranial Doppler, tympanic membrane displacement, optic nerve sheath diameter, CT scan/MRI and fundoscopy) can be used as reliable alternatives to the invasive techniques (ventriculostomy and microtransducers). Ventriculostomy is considered the gold standard in terms of accurate measurement of pressure, although microtransducers generally are just as accurate. Both invasive techniques are associated with a minor risk of complications such as hemorrhage and infection. Furthermore, zero drift is a problem with selected microtransducers. The non-invasive techniques are without the invasive methods' risk of complication, but fail to measure ICP accurately enough to be used as routine alternatives to invasive measurement. We conclude that invasive measurement is currently the only option for accurate measurement of ICP.

No MeSH data available.


Related in: MedlinePlus