Intracranial Pressure Monitoring

Intracranial pressure (ICP) is the pressure exerted within the cranium by the intracranial contents. The normal range of ICP is 7–15 mmHg for adults. Any value more than 20–25 mmHg is considered abnormal and requires treatment. There are numerous invasive and non-invasive techniques of monitoring ICP. Ventricular catheter-based monitoring is the most invasive technique but is the gold standard due to its high accuracy, low cost, and ability to serve diagnostic and therapeutic purposes. The ICP waveform obtained from invasive monitoring provides information about intracranial compliance and helps predict the future occurrence of raised ICP. Non-invasive monitoring techniques such as transcranial Doppler and optic nerve sheath diameter on ultrasonography are increasingly used at the bedside due to point-of-care accessibility, non-invasiveness, low cost, and repeatability. The ICP monitoring is indicated in patients with severe brain injury, in patients where frequent clinical assessment is not possible, and where a decision for escalation of treatment for ICP control is not feasible without ICP monitoring. The monitoring of ICP helps in prognostication and facilitates appropriate interventions to improve neurological outcomes after acute brain injury.