Clinical applications of intracranial pressure monitoring in traumatic brain injury : report of the Milan consensus conference.

摘要: Intracranial pressure (ICP) monitoring has been for decades a cornerstone of traumatic brain injury (TBI) management. Nevertheless, in recent years, its usefulness questioned several reports. A group neurosurgeons and neurointensivists met to openly discuss, provide consensus on, practical applications ICP severe adult TBI. conference was held Milan on October 5, 2013, putting together intensivists with recognized expertise treatment Four topics have selected addressed pro-con presentations: 1) indications diffuse injury, 2) cerebral contusions, 3) secondary decompressive craniectomy (DC), 4) after evacuation intracranial hematomas. The participants were asked elaborate the existing published evidence (without systematic review) their personal clinical experience. Based presentations discussions conference, some drafts circulated among attendants. After remarks further contributions collected, final document approved by participants. made following recommendations: comatose TBI patients, case normal computed tomography (CT) scan, there is no indication monitoring; indicated patients contusions whom interruption sedation check neurological status dangerous when examination not completely reliable. probe should be positioned side larger contusion; generally recommended DC order assess effectiveness terms control guide therapy; an acute supratentorial hematoma considered salvageable at increased risk hypertension particular perioperative features.