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ICP monitoring..

All patients with severe head injury and moderate head injury whose progress can not be followed by serial neurological evaluation should be considered for ICP monitoring.

The Brain Trauma Foundation guidelines suggest ICP-monitoring should be considered in the following settings:

· Severe head injury (GCS 3-8) + abnormal CT scan
· Severe head injury (GCS 3-8) + normal CT scan if 2 of the following are present:
o Age > 40
o BP < 90 mmHg
o Abnormal motor posturing

Individual intracranial pressure monitors have different limitations:

· Intraparenchymal monitors/subdural bolts: can not be calibrated, subject to “drift”, do not allow CSF drainage for control of ICP
· Require expertise and resource availability for placement
· Infection

No RCTs have demonstrated that ICP-guided therapy improves patient centred outcomes.

Some observational studies have noted an association between ICP guided management and prolonged length of stay (Cramer, 2005) and worse outcome (Shafi, 2008).
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