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Routine intracranial pressure monitoring in acute comaForsyth RJ, Rodriguez B
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SummaryNo evidence from trials to show the effects of routine monitoring of intracranial pressure following head injuryThe brain is situated in a rigid box (the skull) that cannot expand, so normal swelling from injury cannot occur. When brain swelling does occur, pressure inside the skull rises. This makes it harder for the heart to pump the oxygen and blood into the brain needed for recovery. If this swelling is not controlled, further brain damage is caused. Efforts to avoid this damage can include routine monitoring of the pressure inside the skull (intracranial). The review of trials found no evidence to show the effects of routine measurement of pressure in the skull. More research is needed.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
July 23. 2001 AbstractBackgroundStudies in traumatic encephalopathy first led to the insight that the damage seen was not just due to direct consequences of the primary injury. A significant, and potentially preventable, contribution to the overall morbidity arose from secondary hypoxic-ischaemic damage. Brain swelling accompanied by raised intracranial pressure (ICP) resulted in inadequate cerebral perfusion with well-oxygenated blood. Detection of raised ICP could be useful in alerting clinicians to the need to improve cerebral perfusion, with consequent reductions in brain injury. ObjectivesTo determine whether routine ICP monitoring in all acute cases of severe coma reduces the risk of all-cause mortality or severe disability at final follow-up. Search strategyWe searched the Cochrane Injuries Group's specialised register, CENTRAL, MEDLINE, EMBASE and the Index of Scientific and Technical Proceedings. We also checked the reference lists of all relevant articles. The searches were last updated in April 2006. Selection criteriaAll randomised controlled studies of real-time ICP monitoring by invasive or semi-invasive means in acute coma (traumatic or non-traumatic aetiology) versus no ICP monitoring (that is, clinical assessment of ICP). Data collection and analysisPrimary outcome measures were all-cause mortality and severe disability at the end of the follow-up period. Main resultsNo studies meeting the selection criteria have been identified to date. Authors' conclusionsThere are no data from randomised controlled trials that can clarify the role of ICP monitoring in acute coma. |