CONTROVERSIES OF ICP MONITORING

Dilemma about which patients should be treated

and at what ICP level.

Brain resuscitation after TBI based exclusively on control of ICP levels and CPP does

not prevent cerebral hypoxia more than 20% of patients.

They are global measurements and

sometimes a small but very important cerebral region is suffering very much without

global modifications

• What is the target ICP

• Does ICP Monitoring and Management Improve Outcome

An “aggressive” management protocol was associated with decreased risk of mortality

A meta-analysis published in 2010 found that ICP monitoring and aggressive treatment of intracranial hypertension in severe TBI is associated with improved outcomes

Whereas some studies have suggested that it might in fact be detrimental.

The worse outcomes observed in some studies might also be a result of the deleterious effects of the ICP-reducing therapy itself.

In a retrospective trial, demonstrated in 5-year study there was no statistical difference & there was no difference in the six-month mortality between the 2 groups (TBI management based on ICP & serial imaging CT scans).

These conflicting findings are likely to be related to several

factors including :- Lack of standardization of clinical management between centres enrolled in studies, - Different indications and thresholds for ICP monitoring between centres, - Differences in study design and quality, - Lack of control for confounding factors between groups of patients that did and did not undergo ICP monitoring.