Mathur Rohan, Cheng Lin, Lim Josiah, Azad Tej D, Dziedzic Peter, Belkin Eleanor, Joseph Ivanna, Bhende Bhagyashri, Yellapantula Sudha, Potu Niteesh, Lefebvre Austen, Shah Vishank, Muehlschlegel Susanne, Bosel Julian, Budavari Tamas, Suarez Jose I
Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neurotherapeutics. 2025 Jan;22(1):e00507. doi: 10.1016/j.neurot.2024.e00507. Epub 2025 Jan 3.
A wide range of acute brain injuries, including both traumatic and non-traumatic causes, can result in elevated intracranial pressure (ICP), which in turn can cause further secondary injury to the brain, initiating a vicious cascade of propagating injury. Elevated ICP is therefore a neurological injury that requires intensive monitoring and time-sensitive interventions. Patients at high risk for developing elevated ICP undergo placement of invasive ICP monitors including external ventricular drains, intraparenchymal ICP monitors, and lumbar drains. These monitors all generate an ICP waveform, but each has its own unique caveats in monitoring and accuracy. Current ICP monitoring and management clinical guidelines focus on the mean ICP derived from the ICP waveform, with standard thresholds of treating ICP greater than 20 mmHg or 22 mmHg applied broadly to a wide range of patients. However, this one-size fits all approach has been criticized and there is a need to develop personalized, evidence-based and possibly multi-factorial precision-medicine based approaches to the problem. This paper provides historical and physiological context to the problem of elevated ICP, provides an overview of the challenges of the current paradigm of ICP management strategies, and discusses advances in ICP waveform analysis, emerging non-invasive ICP monitoring techniques, and applications of machine learning to create predictive algorithms.
多种急性脑损伤，包括创伤性和非创伤性原因，均可导致颅内压（ICP）升高，进而可引起大脑进一步的继发性损伤，引发损伤扩散的恶性循环。因此，颅内压升高是一种需要密切监测和及时干预的神经损伤。有发生颅内压升高风险的患者需要放置有创颅内压监测器，包括外置脑室引流管、脑实质内颅内压监测器和腰大池引流管。这些监测器都会生成颅内压波形，但每种在监测和准确性方面都有其独特的注意事项。当前的颅内压监测和管理临床指南侧重于从颅内压波形得出的平均颅内压，标准治疗阈值为颅内压大于20 mmHg或22 mmHg，广泛应用于各类患者。然而，这种一刀切的方法受到了批评，需要针对该问题制定个性化、基于证据且可能是多因素的精准医学方法。本文阐述了颅内压升高问题的历史和生理背景，概述了当前颅内压管理策略模式面临的挑战，并讨论了颅内压波形分析的进展、新兴的无创颅内压监测技术以及机器学习在创建预测算法方面的应用。
