Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations

Authors

Randall M. Chesnut, Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Sergio Aguilera, Almirante Nef Naval Hospital, Valparaiso University, Viña Del Mar, Chile.
Andras Buki, Department of Neurosurgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Eileen M. Bulger, Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
Giuseppe Citerio, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
D Jamie Cooper, Intensive Care Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
Ramon Diaz Arrastia, Department of Neurology, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Michael Diringer, Department of Neurology, Washington University School of Medicine, St Louis, USA.
Anthony Figaji, Division of Neurosurgery and Neuroscience Institute, Groote Schuur Hospital, University of Cape Town, Observatory 7925, South Africa.
Guoyi Gao, Department of Neurosurgery, Renji Hospital, Shanghai Institute of Head Trauma, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Romergryko G. Geocadin, Departments of Neurology, Neurological Surgery, Anesthesiology-Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Jamshid Ghajar, Department of Neurosurgery, Stanford Neuroscience Health Center, Palo Alto, California, USA.
Odette Harris, Department of Neurosurgery, Stanford University School of Medicine, Center for Academic Medicine, Stanford, California, USA.
Gregory W. Hawryluk, Cleveland Clinic Akron General Neurosciences Center, Fairlawn, Ohio, USA.
Alan Hoffer, UH Cleveland Medical Center, Cleveland, Ohio, USA.
Peter Hutchinson, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge and Cambridge Biomedical Campus, Cambridge, UK.
Mathew Joseph, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
Ryan Kitagawa, Vivian L Smith Department of Neurosurgery, McGovern Medical School at UTHealth, Houston, Texas, USA.
Geoffrey Manley, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Stephan Mayer, Westchester Health Network, New York Medical College, Valhalla, New York, USA.
David K. Menon, Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK.
Geert Meyfroidt, Department of Intensive Care Medicine, University Hospitals Leuven and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
Daniel B. Michael, Department of Neurosurgery, Beaumont Health, Michigan Head and Spine Institute, Oakland University William Beaumont School of Medicine, Southfield, Michigan, USA.
Mauro Oddo, CHUV Medical Directorate and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
David O. Okonkwo, Department of Neurosurgery, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, Pennsylvania, USA.
Mayur B. Patel, Department of Surgery, Division of Acute Care Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Claudia Robertson, Department of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA.
Jeffrey V. Rosenfeld, Department of Neurosurgery, Alfred Hospital, Melbourne, Australia.
Andres M. Rubiano, INUB/MEDITECH Research Group, Neurosciences Institute, El Bosque University, Bogotá, Colombia.
Juain Sahuquillo, Department of Neurosurgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona: Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
Franco Servadei, Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Milano, Italy.
Lori Shutter, Department of Critical Care Medicine, Neurology and Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Author Type(s)

Faculty

Journal Title

Neurosurgery

First Page

399

Last Page

408

Document Type

Article

Publication Date

8-1-2023

Department

Neurology

Abstract

BACKGROUND: Intracranial pressure (ICP) monitoring is widely practiced, but the indications are incompletely developed, and guidelines are poorly followed. OBJECTIVE: To study the monitoring practices of an established expert panel (the clinical working group from the Seattle International Brain Injury Consensus Conference effort) to examine the match between monitoring guidelines and their clinical decision-making and offer guidance for clinicians considering monitor insertion. METHODS: We polled the 42 Seattle International Brain Injury Consensus Conference panel members' ICP monitoring decisions for virtual patients, using matrices of presenting signs (Glasgow Coma Scale [GCS] total or GCS motor, pupillary examination, and computed tomography diagnosis). Monitor insertion decisions were yes, no, or unsure (traffic light approach). We analyzed their responses for weighting of the presenting signs in decision-making using univariate regression. RESULTS: Heatmaps constructed from the choices of 41 panel members revealed wider ICP monitor use than predicted by guidelines. Clinical examination (GCS) was by far the most important characteristic and differed from guidelines in being nonlinear. The modified Marshall computed tomography classification was second and pupils third. We constructed a heatmap and listed the main clinical determinants representing 80% ICP monitor insertion consensus for our recommendations. CONCLUSION: Candidacy for ICP monitoring exceeds published indicators for monitor insertion, suggesting the clinical perception that the value of ICP data is greater than simply detecting and monitoring severe intracranial hypertension. Monitor insertion heatmaps are offered as potential guidance for ICP monitor insertion and to stimulate research into what actually drives monitor insertion in unconstrained, real-world conditions.

Recommended Citation

Chesnut, R. M., Aguilera, S., Buki, A., Bulger, E. M., Citerio, G., Cooper, D. J., Arrastia, R. D., Diringer, M., Figaji, A., Gao, G., Geocadin, R. G., Ghajar, J., Harris, O., Hawryluk, G. W., Hoffer, A., Hutchinson, P., Joseph, M., Kitagawa, R., Manley, G., Mayer, S., Menon, D. K., Meyfroidt, G., Michael, D. B., Oddo, M., Okonkwo, D. O., Patel, M. B., Robertson, C., Rosenfeld, J. V., Rubiano, A. M., Sahuquillo, J., Servadei, F., & Shutter, L. (2023). Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations. Neurosurgery, 93 (2), 399-408. https://doi.org/10.1227/neu.0000000000002516