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Observational Study
. 2025 Jun 13;29(1):237.
doi: 10.1186/s13054-025-05384-w.

From indication to initiation of invasive intracranial pressure monitoring time differences between neurosurgeons and intensive care physicians: can intracranial hypertension dose be reduced? TIMING-ICP, a multicenter, observational, prospective study

Lara Mariani  1   2 , Stefano Calza  3 , Paolo Gritti  4 , Simone Maria Zerbi  5 , Emanuele Russo  6 , Cristian Deana  7 , Dario Filippi  4 , Chiara Robba  8   9 , Anselmo Caricato  10 , Paola Fassini  11 , Giacomo Dell'Avanzo  4 , Andrea Viscone  4 , Lucio De Maria  12 , Luca Pisapia  10 , Luigi Vetrugno  13 , Gianluigi Zona  14 , Roberto Stefini  15 , Corrado Iaccarino  16   17   18 , Nicola Latronico  19   20 , Simone Piva  19   20 , Michele Bertoni  19   20 , Antonio Biroli  21 , Marco Maria Fontanella  19   12 , Frank Rasulo  19   22
Affiliations
Observational Study

From indication to initiation of invasive intracranial pressure monitoring time differences between neurosurgeons and intensive care physicians: can intracranial hypertension dose be reduced? TIMING-ICP, a multicenter, observational, prospective study

Lara Mariani et al. Crit Care. .

Abstract

Background: The duration of episodes of intracranial hypertension is related to poor outcome, hence the need for prompt diagnosis. Numerous issues can lead to delays in the implementation of invasive intracranial pressure (ICP) monitoring, thereby increasing the dose of intracranial hypertension to which the patient is exposed. The aim of this prospective, observational, multicenter study was to assess the magnitude of this delay, evaluating the time required for initiation of invasive ICP monitoring, from indication (T1) to initiation of the maneuver (T2) when performed by neurosurgeons compared to intensive care physicians.

Methods: We evaluated the impact of the operator performing the maneuver (neurosurgeon vs. intensivist) on the T2-T1 time interval, where T1 represents the time at which indication for invasive ICP monitoring is declared, and T2 the time at which the maneuver starts, defined as the skin incision. The effect of the operator performing the maneuver was evaluated through a parametric survival model. Both intraparenchymal catheters (IPCs) and external ventricular drains (EVDs) were considered as invasive ICP monitoring devices. Invasive monitoring could be performed in intensive care unit (ICU) or in operating room (OR).

Results: A total of 112 patients were included into the final analysis; 39 IPCs were placed by intensivists within the ICU, and a total of 73 IPCs and EVDs by neurosurgeons both within the ICU and OR settings. The mean difference in T2-T1 time for IPCs placement in the ICU was 69 min (CI 50.1-94.8) in the intensivist group and 145 min (CI 103.4-202.9) in neurosurgeon group. The mean difference between these groups, 76 min, was found to be statistically significant (p-value = 0.0021). In the group treated by neurosurgeons, no statistically significant differences were found in timing between the ICU and the OR.

Conclusions: Invasive ICP monitoring performed with IPCs in ICU begins earlier when performed by intensivists rather than neurosurgeons. This finding suggests the possibility to obtain a prompt diagnosis of intracranial hypertension when intensivists intervein directly at patient's bedside. Further studies are needed to confirm these findings and investigate their effect on outcome.

Keywords: Intensive care physicians; Intracranial hypertension; Intracranial pressure dose; Intraparenchymal catheters; Invasive intracranial pressure monitoring; Neurosurgeons.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol and its amendments were approved by the ethics committee of Brescia, located at Spedali Civili Hospital, Brescia, (NP 4628) and subsequently by the ethics committees of the centres participating in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Visual representation of the study design. T1 is the moment at which invasive intracranial pressure monitoring is stated; T2 is the moment at which skin incision is performed to allow intracranial device placement. ICU: Intensive Care Unit, ER; Emergency Room, OR: operatory room
Fig. 2
Fig. 2
The flow chart illustrates the process of selection of eligible patients and their division into two groups according to the specialist who placed the invasive intracranial pressure monitoring device. The location where the device was placed is also indicated. IPC: intraparenchymal catheter, EVD: external ventricular drain, ICU: intensive care unit, OR: operatory room
Fig. 3
Fig. 3
Results of the study divided according to the intervening specialist. The neurosurgery section shows the results by both the type of device placed (intervention) and the location where the maneuver was performed (location). ICU: intensive care unit, OR: operating room; ΔT: T2-T1
See this image and copyright information in PMC

Comment in

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