Shim Youngbo, Kim Jungook, Kim Hye Seon, Oh Jiwoong, Lee Seungioo, Ha Eun Jin
Department of Critical Care Medicine, Kangbuk Samsung Hospital, Seoul, Korea.
Gachon University Gil Hospital Regional Trauma Center, Gachon, Korea.
Korean J Neurotrauma. 2023 Jun 28;19(2):149-161. doi: 10.13004/kjnt.2023.19.e32. eCollection 2023 Jun.
While there is no level I recommendation for intracranial pressure (ICP) monitoring, it is typically indicated for patients with severe traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) score of 3-8 (class II). Even for moderate TBI patients with GCS 9-12, ICP monitoring should be considered for risk of increased ICP. The impact of ICP monitoring on patient outcomes is still not well-established, but recent studies reported a reduction of early mortality (class III) in TBI patients. There is no standard protocol for the application of ICP monitoring. In cases where cerebrospinal fluid drainage is required, an external ventricular drain is commonly used. In other cases, parenchymal ICP monitoring devices are generally employed. Subdural or non-invasive forms are not suitable for ICP monitoring. The mean value of ICP is the parameter recommended for observation in many guidelines. In TBI, values above 22 mmHg are associated with increased mortality. However, recent studies proposed various parameters including cumulative time with ICP above 20 mmHg (pressure-time dose), pressure reactivity index, ICP waveform characteristics (pulse amplitude of ICP, mean ICP wave amplitude), and the compensatory reserve of the brain (reserve-amplitude-pressure), which are useful in predicting patient outcomes and guiding treatment. Further research is required for validation of these parameters compared to simple ICP monitoring.
虽然对于颅内压（ICP）监测尚无一级推荐，但通常适用于格拉斯哥昏迷量表（GCS）评分为3 - 8分的重度创伤性脑损伤（TBI）患者（二级）。即使对于GCS评分为9 - 12分的中度TBI患者，也应考虑进行ICP监测，以防ICP升高。ICP监测对患者预后的影响仍未明确，但最近的研究报告称TBI患者的早期死亡率有所降低（三级）。目前尚无应用ICP监测的标准方案。在需要引流脑脊液的情况下，通常使用外置脑室引流管。在其他情况下，一般采用脑实质ICP监测设备。硬膜下或无创形式不适用于ICP监测。许多指南推荐将ICP的平均值作为观察参数。在TBI中，ICP值高于22 mmHg与死亡率增加相关。然而，最近的研究提出了各种参数，包括ICP高于20 mmHg的累计时间（压力 - 时间剂量）、压力反应性指数、ICP波形特征（ICP的脉冲幅度、平均ICP波幅度）以及大脑的代偿储备（储备 - 幅度 - 压力），这些参数有助于预测患者预后并指导治疗。与简单的ICP监测相比，这些参数的验证还需要进一步研究。
