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Review
. 2022 Apr 1;28(2):101-110.
doi: 10.1097/MCC.0000000000000920.

Intracranial pressure management: moving beyond guidelines

Andres M Rubiano  1 , Anthony Figaji  2 , Gregory W Hawryluk  3
Affiliations
Review

Intracranial pressure management: moving beyond guidelines

Andres M Rubiano et al. Curr Opin Crit Care. .

Abstract

Purpose of review: The aim of this study was to provide an overview on advances in intracranial pressure (ICP) protocols for care, moving from traditional to more recent concepts.

Recent findings: Deep understanding of mechanics and dynamics of fluids and solids have been introduced for intracranial physiology. The amplitude or the harmonics of the cerebral-spinal fluid and the cerebral blood waves shows more information about ICP than just a numeric threshold. When the ICP overcome the compensatory mechanisms that maintain the compliance within the skull, an intracranial compartment syndrome (ICCS) is defined. Autoregulation monitoring emerge as critical tool to recognize CPP management. Measurement of brain tissue oxygen will be a critical intervention for diagnosing an ICCS. Surgical procedures focused on increasing the physiological compliance and increasing the volume of the compartments of the skull.

Summary: ICP management is a complex task, moving far than numeric thresholds for activation of interventions. The interactions of intracranial elements requires new interpretations moving beyond classical theories. Most of the traditional clinical studies supporting ICP management are not generating high class evidence. Recommendations for ICP management requires better designed clinical studies using new concepts to generate interventions according to the new era of personalized medicine.

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References

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