University Division of Anaesthesia, Cambridge University Hospitals Foundation Trust, UK.
Curr Opin Anaesthesiol. 2011 Apr;24(2):117-23. doi: 10.1097/ACO.0b013e32834458c5.
The review touches upon the current physiopathological concepts relating to the field of intracranial pressure (ICP) monitoring and offers an up-to-date overview of the ICP monitoring technologies and of the signal-analysis techniques relevant to clinical practice.
Improved ICP probes, antibiotic-impregnated ventricular catheters and multimodality, computerized systems allow ICP monitoring and individualized optimization of brain physiology. Noninvasive technologies for ICP and cerebral perfusion pressure assessment are being tested in the clinical arena. Computerized morphological analysis of the ICP pulse-waveform can provide an indicator of global cerebral perfusion.
Current recommendations for the management of traumatic brain injury indicate ICP monitoring in patients who remain comatose after resuscitation if the admission computed tomography scan reveals intracranial abnormalities such as haematomas, contusions and cerebral oedema. The most reliable methods of ICP monitoring are ventricular catheters and intraparenchymal systems. A growing number of these devices are being safely placed by neurointensivists. The consensus is to treat ICP exceeding the 20 mmHg threshold, and to target cerebral perfusion pressure between 50 and 70 mmHg. Recent evidence suggests that such thresholds should be optimized based on multimodality monitoring and individual brain physiology. Noninvasive ICP estimation using transcranial Doppler can have a role as a screening tool in patients with low to intermediate risk of developing intracranial hypertension. However, the technology remains insufficiently accurate and too cumbersome for continuous ICP monitoring.
本文述及了与颅内压（ICP）监测相关的当前病理生理学概念，并对 ICP 监测技术和相关的临床信号分析技术进行了最新的概述。
改进的 ICP 探头、抗生素浸渍的脑室导管和多模态、计算机化系统允许进行 ICP 监测和脑生理的个体化优化。用于 ICP 和脑灌注压评估的非侵入性技术正在临床领域进行测试。对 ICP 脉搏波形态的计算机形态分析可提供全脑灌注的指标。
目前对创伤性脑损伤的管理建议指出，如果入院计算机断层扫描显示颅内存在血肿、挫伤和脑水肿等异常，那么在复苏后仍处于昏迷状态的患者需要进行 ICP 监测。最可靠的 ICP 监测方法是脑室导管和脑实质内系统。越来越多的这些设备被神经重症监护医生安全地放置。共识是治疗 ICP 超过 20mmHg 的阈值，并将脑灌注压目标定在 50 至 70mmHg 之间。最近的证据表明，应根据多模态监测和个体脑生理学来优化这些阈值。使用经颅多普勒进行无创 ICP 估计可以作为颅内高压风险较低至中等的患者的筛选工具。然而，该技术仍然不够准确，并且对于连续 ICP 监测来说过于繁琐。
