Clinical applications of intracranial pressure monitoring in traumatic brain injury: Report of the Milan consensus conference
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 con...
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| creator | Stocchetti, Nino Picetti, Edoardo Berardino, Maurizio Buki, Andràs Chesnut, Randall M. Fountas, Kostas N. Horn, Peter Hutchinson, Peter J. Iaccarino, Corrado Kolias, Angelos G. Koskinen, Lars-Owe Latronico, Nicola Maas, Andrews I. R. Payen, Jean-François Rosenthal, Guy Sahuquillo, Juan Signoretti, Stefano Soustiel, Jean F. Servadei, Franco |
| description | 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. |
| doi_str_mv | 10.1007/s00701-014-2127-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1555013068</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1545777849</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2724-8f9553cbb02b616f25f0e00346c3d3f9be31f963484f23be358faa5e1e1e9ca33</originalsourceid><addsrcrecordid>eNqNkU1LxDAQhoMo7rr6A7xIwYuXar7bHmXxCwQP6jmk2USytGlNtof9907tKiIIEpjMMM_MJPMidErwJcG4uEpgMMkx4TkltMj5HprjitMcDN4HH0NWUlnO0FFKa4howdkhmlFe8opVZI6el40P3ugm033fgLPxXUhZ5zIfNlGbqIOHZB9tSkO0WdsFv-miD28AZEAMLZSYrI4aYh_WQ9weowOnm2RPdvcCvd7evCzv88enu4fl9WNuaEF5XrpKCGbqGtNaEumocNhizLg0bMVcVVtGXCUZvNVRBpEondbCEjiV0Ywt0MXUt4_d-2DTRrU-Gds0OthuSIoIITBhWJb_QLkoimLcygKd_0LX3RADfOSTIlJIiYEiE2Vil1K0TvXRtzpuFcFqFEdN4igQR43iKA41Z7vOQ93a1XfFlxoA0AlI_bhhG3-M_rPrB-tUmTc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1545165660</pqid></control><display><type>article</type><title>Clinical applications of intracranial pressure monitoring in traumatic brain injury: Report of the Milan consensus conference</title><source>MEDLINE</source><source>SpringerNature Complete Journals</source><creator>Stocchetti, Nino ; Picetti, Edoardo ; Berardino, Maurizio ; Buki, Andràs ; Chesnut, Randall M. ; Fountas, Kostas N. ; Horn, Peter ; Hutchinson, Peter J. ; Iaccarino, Corrado ; Kolias, Angelos G. ; Koskinen, Lars-Owe ; Latronico, Nicola ; Maas, Andrews I. R. ; Payen, Jean-François ; Rosenthal, Guy ; Sahuquillo, Juan ; Signoretti, Stefano ; Soustiel, Jean F. ; Servadei, Franco</creator><creatorcontrib>Stocchetti, Nino ; Picetti, Edoardo ; Berardino, Maurizio ; Buki, Andràs ; Chesnut, Randall M. ; Fountas, Kostas N. ; Horn, Peter ; Hutchinson, Peter J. ; Iaccarino, Corrado ; Kolias, Angelos G. ; Koskinen, Lars-Owe ; Latronico, Nicola ; Maas, Andrews I. R. ; Payen, Jean-François ; Rosenthal, Guy ; Sahuquillo, Juan ; Signoretti, Stefano ; Soustiel, Jean F. ; Servadei, Franco</creatorcontrib><description>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.</description><identifier>ISSN: 0001-6268</identifier><identifier>EISSN: 0942-0940</identifier><identifier>DOI: 10.1007/s00701-014-2127-4</identifier><identifier>PMID: 24849391</identifier><language>eng</language><publisher>Vienna: Springer Vienna</publisher><subject>Adult ; Brain Injuries - complications ; Brain Injuries - physiopathology ; Brain Injuries - surgery ; Clinical Article - Conference Report ; Consensus ; Decompressive Craniectomy ; Humans ; Interventional Radiology ; Intracranial Hypertension - etiology ; Intracranial Hypertension - physiopathology ; Intracranial Hypertension - surgery ; Intracranial Pressure - physiology ; Medicine ; Medicine & Public Health ; Minimally Invasive Surgery ; Monitoring, Physiologic ; Neurology ; Neuroradiology ; Neurosurgery ; Surgical Orthopedics</subject><ispartof>Acta neurochirurgica, 2014-08, Vol.156 (8), p.1615-1622</ispartof><rights>Springer-Verlag Wien 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2724-8f9553cbb02b616f25f0e00346c3d3f9be31f963484f23be358faa5e1e1e9ca33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00701-014-2127-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00701-014-2127-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24849391$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stocchetti, Nino</creatorcontrib><creatorcontrib>Picetti, Edoardo</creatorcontrib><creatorcontrib>Berardino, Maurizio</creatorcontrib><creatorcontrib>Buki, Andràs</creatorcontrib><creatorcontrib>Chesnut, Randall M.</creatorcontrib><creatorcontrib>Fountas, Kostas N.</creatorcontrib><creatorcontrib>Horn, Peter</creatorcontrib><creatorcontrib>Hutchinson, Peter J.</creatorcontrib><creatorcontrib>Iaccarino, Corrado</creatorcontrib><creatorcontrib>Kolias, Angelos G.</creatorcontrib><creatorcontrib>Koskinen, Lars-Owe</creatorcontrib><creatorcontrib>Latronico, Nicola</creatorcontrib><creatorcontrib>Maas, Andrews I. R.</creatorcontrib><creatorcontrib>Payen, Jean-François</creatorcontrib><creatorcontrib>Rosenthal, Guy</creatorcontrib><creatorcontrib>Sahuquillo, Juan</creatorcontrib><creatorcontrib>Signoretti, Stefano</creatorcontrib><creatorcontrib>Soustiel, Jean F.</creatorcontrib><creatorcontrib>Servadei, Franco</creatorcontrib><title>Clinical applications of intracranial pressure monitoring in traumatic brain injury: Report of the Milan consensus conference</title><title>Acta neurochirurgica</title><addtitle>Acta Neurochir</addtitle><addtitle>Acta Neurochir (Wien)</addtitle><description>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.</description><subject>Adult</subject><subject>Brain Injuries - complications</subject><subject>Brain Injuries - physiopathology</subject><subject>Brain Injuries - surgery</subject><subject>Clinical Article - Conference Report</subject><subject>Consensus</subject><subject>Decompressive Craniectomy</subject><subject>Humans</subject><subject>Interventional Radiology</subject><subject>Intracranial Hypertension - etiology</subject><subject>Intracranial Hypertension - physiopathology</subject><subject>Intracranial Hypertension - surgery</subject><subject>Intracranial Pressure - physiology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minimally Invasive Surgery</subject><subject>Monitoring, Physiologic</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosurgery</subject><subject>Surgical Orthopedics</subject><issn>0001-6268</issn><issn>0942-0940</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkU1LxDAQhoMo7rr6A7xIwYuXar7bHmXxCwQP6jmk2USytGlNtof9907tKiIIEpjMMM_MJPMidErwJcG4uEpgMMkx4TkltMj5HprjitMcDN4HH0NWUlnO0FFKa4howdkhmlFe8opVZI6el40P3ugm033fgLPxXUhZ5zIfNlGbqIOHZB9tSkO0WdsFv-miD28AZEAMLZSYrI4aYh_WQ9weowOnm2RPdvcCvd7evCzv88enu4fl9WNuaEF5XrpKCGbqGtNaEumocNhizLg0bMVcVVtGXCUZvNVRBpEondbCEjiV0Ywt0MXUt4_d-2DTRrU-Gds0OthuSIoIITBhWJb_QLkoimLcygKd_0LX3RADfOSTIlJIiYEiE2Vil1K0TvXRtzpuFcFqFEdN4igQR43iKA41Z7vOQ93a1XfFlxoA0AlI_bhhG3-M_rPrB-tUmTc</recordid><startdate>201408</startdate><enddate>201408</enddate><creator>Stocchetti, Nino</creator><creator>Picetti, Edoardo</creator><creator>Berardino, Maurizio</creator><creator>Buki, Andràs</creator><creator>Chesnut, Randall M.</creator><creator>Fountas, Kostas N.</creator><creator>Horn, Peter</creator><creator>Hutchinson, Peter J.</creator><creator>Iaccarino, Corrado</creator><creator>Kolias, Angelos G.</creator><creator>Koskinen, Lars-Owe</creator><creator>Latronico, Nicola</creator><creator>Maas, Andrews I. R.</creator><creator>Payen, Jean-François</creator><creator>Rosenthal, Guy</creator><creator>Sahuquillo, Juan</creator><creator>Signoretti, Stefano</creator><creator>Soustiel, Jean F.</creator><creator>Servadei, Franco</creator><general>Springer Vienna</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201408</creationdate><title>Clinical applications of intracranial pressure monitoring in traumatic brain injury</title><author>Stocchetti, Nino ; Picetti, Edoardo ; Berardino, Maurizio ; Buki, Andràs ; Chesnut, Randall M. ; Fountas, Kostas N. ; Horn, Peter ; Hutchinson, Peter J. ; Iaccarino, Corrado ; Kolias, Angelos G. ; Koskinen, Lars-Owe ; Latronico, Nicola ; Maas, Andrews I. 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R.</creatorcontrib><creatorcontrib>Payen, Jean-François</creatorcontrib><creatorcontrib>Rosenthal, Guy</creatorcontrib><creatorcontrib>Sahuquillo, Juan</creatorcontrib><creatorcontrib>Signoretti, Stefano</creatorcontrib><creatorcontrib>Soustiel, Jean F.</creatorcontrib><creatorcontrib>Servadei, Franco</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Acta neurochirurgica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stocchetti, Nino</au><au>Picetti, Edoardo</au><au>Berardino, Maurizio</au><au>Buki, Andràs</au><au>Chesnut, Randall M.</au><au>Fountas, Kostas N.</au><au>Horn, Peter</au><au>Hutchinson, Peter J.</au><au>Iaccarino, Corrado</au><au>Kolias, Angelos G.</au><au>Koskinen, Lars-Owe</au><au>Latronico, Nicola</au><au>Maas, Andrews I. R.</au><au>Payen, Jean-François</au><au>Rosenthal, Guy</au><au>Sahuquillo, Juan</au><au>Signoretti, Stefano</au><au>Soustiel, Jean F.</au><au>Servadei, Franco</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical applications of intracranial pressure monitoring in traumatic brain injury: Report of the Milan consensus conference</atitle><jtitle>Acta neurochirurgica</jtitle><stitle>Acta Neurochir</stitle><addtitle>Acta Neurochir (Wien)</addtitle><date>2014-08</date><risdate>2014</risdate><volume>156</volume><issue>8</issue><spage>1615</spage><epage>1622</epage><pages>1615-1622</pages><issn>0001-6268</issn><eissn>0942-0940</eissn><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.</abstract><cop>Vienna</cop><pub>Springer Vienna</pub><pmid>24849391</pmid><doi>10.1007/s00701-014-2127-4</doi><tpages>8</tpages></addata></record> |
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| subjects | Adult Brain Injuries - complications Brain Injuries - physiopathology Brain Injuries - surgery Clinical Article - Conference Report Consensus Decompressive Craniectomy Humans Interventional Radiology Intracranial Hypertension - etiology Intracranial Hypertension - physiopathology Intracranial Hypertension - surgery Intracranial Pressure - physiology Medicine Medicine & Public Health Minimally Invasive Surgery Monitoring, Physiologic Neurology Neuroradiology Neurosurgery Surgical Orthopedics |
| title | Clinical applications of intracranial pressure monitoring in traumatic brain injury: Report of the Milan consensus conference |
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