Section of Neurosurgery, University of Manitoba, GB1, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
Intensive Care Med. 2022 Oct;48(10):1471-1481. doi: 10.1007/s00134-022-06786-y. Epub 2022 Jul 11.
Intracranial pressure (ICP) monitoring is now viewed as integral to the clinical care of many life-threatening brain insults, such as severe traumatic brain injury, subarachnoid hemorrhage, and malignant stroke. It serves to warn of expanding intracranial mass lesions, to prevent or treat herniation events as well as pressure elevation which impedes nutrient delivery to the brain. It facilitates the calculation of cerebral perfusion pressure (CPP) and the estimation of cerebrovascular autoregulatory status. Despite advancements in our knowledge emanating from a half century of experience with this technology, important controversies remain related even to fundamental aspects of ICP measurements, including indications for monitoring, ICP treatment thresholds, and management of intracranial hypertension. Here, we review the history of ICP monitoring, the underlying pathophysiology as well as current perspectives on why, when and how ICP monitoring is best used. ICP is typically assessed invasively but a number of emerging, non-invasive technologies with inherently lower risk are showing promise. In selected cases, additional neuromonitoring can be used to assist in the interpretation of ICP monitoring information and adapt directed treatment accordingly. Additional efforts to expand the evidence base relevant to ICP monitoring, related technologies and management remain a high priority in neurosurgery and neurocritical care.
颅内压（ICP）监测现在被认为是许多危及生命的脑损伤（如严重创伤性脑损伤、蛛网膜下腔出血和恶性中风）临床治疗的重要组成部分。它可以预警颅内肿块病变的扩大，预防或治疗脑疝事件以及阻碍大脑营养供应的压力升高。它有助于计算脑灌注压（CPP）并估计脑血管自动调节状态。尽管我们从半个世纪的这项技术经验中获得了知识的进步，但即使与 ICP 测量的基本方面相关的重要争议仍然存在，包括监测的适应证、ICP 治疗阈值以及颅内高压的管理。在这里，我们回顾了 ICP 监测的历史、潜在的病理生理学，以及目前关于为什么、何时以及如何最好地使用 ICP 监测的观点。ICP 通常是通过有创方式进行评估的，但一些具有内在低风险的新兴非侵入性技术也显示出了希望。在某些情况下，额外的神经监测可以用于帮助解释 ICP 监测信息并相应地调整有针对性的治疗。在神经外科和神经危重病学中，扩大与 ICP 监测、相关技术和管理相关的证据基础仍然是一个高度优先事项。
