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01.08.2014 | Clinical Article - Conference Report

Clinical applications of intracranial pressure monitoring in traumatic brain injury

Report of the Milan consensus conference

verfasst von: Nino Stocchetti, Edoardo Picetti, Maurizio Berardino, Andràs Buki, Randall M. Chesnut, Kostas N. Fountas, Peter Horn, Peter J. Hutchinson, Corrado Iaccarino, Angelos G. Kolias, Lars-Owe Koskinen, Nicola Latronico, Andrews I. R. Maas, Jean-François Payen, Guy Rosenthal, Juan Sahuquillo, Stefano Signoretti, Jean F. Soustiel, Franco Servadei

Erschienen in: Acta Neurochirurgica | Ausgabe 8/2014

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Abstract

Background

Intracranial pressure (ICP) monitoring has been for decades a cornerstone of traumatic brain injury (TBI) management. Nevertheless, in recent years, its usefulness has been questioned in several reports. A group of neurosurgeons and neurointensivists met to openly discuss, and provide consensus on, practical applications of ICP in severe adult TBI.

Methods

A consensus conference was held in Milan on October 5, 2013, putting together neurosurgeons and intensivists with recognized expertise in treatment of TBI. Four topics have been selected and addressed in pro-con presentations: 1) ICP indications in diffuse brain injury, 2) cerebral contusions, 3) secondary decompressive craniectomy (DC), and 4) after evacuation of intracranial traumatic hematomas. The participants were asked to elaborate on the existing published evidence (without a systematic review) and their personal clinical experience. Based on the presentations and discussions of the conference, some drafts were circulated among the attendants. After remarks and further contributions were collected, a final document was approved by the participants.

Summary and conclusions

The group made the following recommendations: 1) in comatose TBI patients, in case of normal computed tomography (CT) scan, there is no indication for ICP monitoring; 2) ICP monitoring is indicated in comatose TBI patients with cerebral contusions in whom the interruption of sedation to check neurological status is dangerous and when the clinical examination is not completely reliable. The probe should be positioned on the side of the larger contusion; 3) ICP monitoring is generally recommended following a secondary DC in order to assess the effectiveness of DC in terms of ICP control and guide further therapy; 4) ICP monitoring after evacuation of an acute supratentorial intracranial hematoma should be considered for salvageable patients at increased risk of intracranial hypertension with particular perioperative features.

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Titel: Clinical applications of intracranial pressure monitoring in traumatic brain injury
Report of the Milan consensus conference
verfasst von: Nino Stocchetti
Edoardo Picetti
Maurizio Berardino
Andràs Buki
Randall M. Chesnut
Kostas N. Fountas
Peter Horn
Peter J. Hutchinson
Corrado Iaccarino
Angelos G. Kolias
Lars-Owe Koskinen
Nicola Latronico
Andrews I. R. Maas
Jean-François Payen
Guy Rosenthal
Juan Sahuquillo
Stefano Signoretti
Jean F. Soustiel
Franco Servadei
Publikationsdatum: 01.08.2014
Verlag: Springer Vienna
Erschienen in: Acta Neurochirurgica / Ausgabe 8/2014
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-014-2127-4

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Clinical applications of intracranial pressure monitoring in traumatic brain injury

Report of the Milan consensus conference

Abstract

Background

Methods

Summary and conclusions

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