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Intracranial pressure (ICP)-guided therapy has been the mainstay of treatment of patients with severe traumatic brain injury (TBI), but recent data have questioned its efficacy. The aim of this study was to demonstrate trends in compliance to TBI guidelines and use of ICP-guided care in a mature trauma system.A retrospective analysis was conducted of 36,915 patients with severe TBI collected by the Pennsylvania Trauma Systems Foundation. The registry includes all patients18 years old with a diagnosis of TBI with a Glasgow Coma Scale score ≤8 who were admitted from January 2000 to December 2017.Of 36,915 patients, 73.6% were men with a median age of 43.0 ± 21.3 years. An ICP monitor was placed in 16.3% of all patients. The rate of ICP monitoring ranged from 17.8% of patients in 2000-2004 to 16.7% in 2005-2009, 16.4% in 2010-2014, and 12.8% in 2015-2017 (P 0.001). The most statistically significant decrease was noted from 2014 (16.4%) to 2015 (14.1%, P = 0.042). The percent decrease in ICP monitoring from 2000-2014 to 2015-2017 was equivalent for patients with Glasgow Coma Scale scores of 3-5 (-4.0%) and 6-8 (-4.5%).As studies emerged that demonstrated unclear benefit of ICP monitoring in improving care in patients with severe TBI, there was a significant statewide decline in the use of ICP monitoring after 2014 among all TBI subpopulations despite noteworthy limitations in the aforementioned studies and clear recommendations from the Brain Trauma Foundation guidelines.

Intracranial pressure monitoring (ICP) is based on the doctrine proposed by Monroe and Kellie centuries ago. With the advancement of technology and science, various invasive and non-invasive modalities of monitoring ICP continue to be developed. An ideal monitor to track ICP should be easy to use, accurate, reliable, reproducible, inexpensive and should not be associated with infection or haemorrhagic complications. Although the transducers connected to the extra ventricular drainage continue to be Gold Standard, its association with the likelihood of infection and haemorrhage have led to the search for alternate non-invasive methods of monitoring ICP. While Camino transducers, Strain gauge micro transducer based ICP monitoring devices and the Spiegelberg ICP monitor are the emerging technology in invasive ICP monitoring, optic nerve sheath diameter measurement, venous opthalmodynamometry, tympanic membrane displacement, tissue resonance analysis, tonometry, acoustoelasticity, distortion-product oto-acoustic emissions, trans cranial doppler, electro encephalogram, near infra-red spectroscopy, pupillometry, anterior fontanelle pressure monitoring, skull elasticity, jugular bulb monitoring, visual evoked response and radiological based assessment of ICP are the non-invasive methods which are assessed against the gold standard.

BACKGROUND Primary decompressive craniectomy (DC) is commonly performed for patients with traumatic brain injury (TBI). Some, but not all patients, will benefit from invasive monitoring of intracranial pressure (ICP) after surgery. We intended to identify risk factors for elevated ICP after primary DC to treat TBI. METHODS A retrospective chart review study identified all patients at our institution who underwent primary DC for TBI during the study period and who had ICP monitors placed at the time of surgery. Various preoperative and intraoperative variables were assessed for correlation with the presence of postoperative elevated ICP. RESULTS Postoperative elevated ICP occurred in 36% of patients after DC. In univariate analysis, Glasgow Coma Scale

To examine the frequency of and factors associated with emergency department (ED) intracranial pressure (ICP) monitor placement in severe paediatric traumatic brain injury (TBI).Retrospective, multicentre cohort study of children18 years admitted to the ED with severe TBI and intubated for48 hours from 2007 to 2011.Two hundred and twenty-four children had severe TBI and 75% underwent either ED, operating room (OR) or paediatric intensive care unit (PICU) ICP monitor placement. Four out of five centres placed ICP monitors in the ED, mostly (83%) fibreoptic. Nearly 40% of the patients who received ICP monitors get it placed in the ED (29% overall). Factors associated with ED ICP monitor placement were as follows: age 13 to18 year olds compared to infants (aRR 2.02; 95% CI 1.37, 2.98), longer ED length of stay (LOS) (aRR 1.15; 95% CI 1.08, 1.21), trauma centre designation paediatric only I/II compared to adult/paediatric I/II (aRR 1.71; 95% CI 1.48, 1.98) and higher mean paediatric TBI patient volume (aRR 1.88;95% CI 1.68, 2.11). Adjusted for centre, higher bedside ED staff was associated with longer ED LOS (aRR 2.10; 95% CI 1.06, 4.14).ICP monitors are frequently placed in the ED at paediatric trauma centres caring for children with severe TBI. Both patient and organizational level factors are associated with ED ICP monitor placement.

Traumatic brain injury (TBI) generally influences circadian rhythms and has been implicated changes in circadian rhythm. Whether TBI-induced changes in circadian rhythm may affect the prognosis or recovery from TBI remains to be investigated. Sixty-two patients with TBI were continuously monitored for intracranial pressure (ICP) during the first 24 hours after the implantation of ICP monitor. The data from each patient were analyzed using the least squares fit of a 24-h cosine function by single cosinor method. Parameters of circadian A (Amplitude)/M (MESOR) were used to evaluate the circadian rhythm of the patients. Student’s t-test and Pearson’s chi-squared test were utilized to analyze the differences between good prognosis group and poor prognosis. A linear regression analysis was then applied to calculate the correlation between circadian A/M of ICP and Glasgow Coma Scale (GCS) before discharge, the Extended Glasgow Outcome Scale (GOS-E), the dosage of mannitol, and time spent in the intensiv...

Although intracranial pressure (ICP) monitoring in severe traumatic brain injury (TBI) is recommended by the Brain Trauma Foundation, the benefits remain controversial. We sought to determine the impact of ICP monitor placement on inpatient mortality within a regional trauma system after correcting for selection bias through propensity score matching.Data were collected on all severe TBI cases presenting to 14 trauma centers during the 2-year study period (2009-2010). Inclusion criteria were as follows: blunt injury, Glasgow Coma Scale (GCS) score of 8 or lower in the emergency department, and abnormal intracranial findings on head computed tomography (CT). Two separate multivariate logistic regression models were used to predict ICP monitor placement and inpatient mortality after controlling for demographics, severity of injury, comorbidities, and TBI-specific variables (GCS score, pupil reactivity, international normalized ratio, and nine specific head CT findings). To account for selection bias, we developed a propensity score-matched model to estimate the "true" effect of ICP monitoring on in-hospital mortality.A total of 844 patients met inclusion criteria; 22 died on arrival to the emergency department. Inpatient mortality was 38.8%; 46.0% of the patients underwent ICP monitor placement. Unadjusted mortality rates were significantly lower in the ICP monitoring group (30.7% vs. 45.7%, p0.001). ICP monitor placement was positively associated with CT findings of subdural hematoma, intraparenchymal contusion, and mass effect and negatively associated with age, alcoholism, and elevated international normalized ratio. After adjusting for selection bias via propensity score matching, ICP monitor placement was associated with an 8.3 percentage point reduction in the risk-adjusted mortality rate.ICP monitor placement occurred in only 46% of eligible patients but was associated with significantly decreased mortality after adjusting for baseline risk profile and the propensity to undergo monitoring. As the individual impact of ICP monitoring may vary, future efforts must determine who stands to benefit from invasive monitoring techniques.Therapeutic/care management study, level III.

Background Patients with open chest wounds, either related to trauma or cardiothoracic procedures, are subjected to significant physiologic alterations when undergoing chest wound closure. Sudden increased intrathoracic pressure at closure decreases venous return from the brain to the heart; consequently the total blood volume in the ridged skull increases, resulting in increased intracranial pressure (ICP). Patients with intact cerebrovascular autoregulation can compensate for these sudden changes by adjusting cerebral blood flow to maintain physiologic ICP. In cases where the autoregulatory mechanisms are compromised, such as stroke or trauma, the ICP can become pathologically elevated. If the patient does not have an ICP monitor, the spike in ICP can go unrecognized, compromising cerebral perfusion pressure and resulting in increased morbidity and mortality. Case Description Herein we describe a case of pathologic elevations in ICP captured with an ICP monitor at the time of chest wound closure in a patient with delayed chest wound closure after orthotopic heart transplant and comorbid embolic stroke. Conclusions This case report demonstrates the potential utility of ICP monitoring in patients with impaired cerebrovascular autoregulation with open and manipulated chest wounds from transplant or trauma.

The Brain Trauma Foundation (BTF) recently updated recommendations for intracranial pressure (ICP) monitoring in severe traumatic brain injury (TBI). The effect of ICP monitoring on outcomes is controversial, and compliance with BTF guidelines is variable. The purpose of this study was to assess both compliance and outcomes at level I trauma centers.The American College of Surgeons Trauma Quality Improvement Program database was queried for all patients admitted to level I trauma centers with isolated blunt severe TBI (AIS3, GCS9) who met criteria for ICP monitoring. Patients who had severe extracranial injuries, craniectomy, or death in the first 24h were excluded. Comparison between groups with and without ICP monitoring was made, analyzing demographics, comorbidities, mechanism of injury, head Abbreviated Injury Scale (AIS), vital signs on admission, head CT scan findings. Outcomes included in-hospital mortality, mechanical ventilation days, intensive care unit (ICU) length of stay, hospital length of stay, systemic complications, and functional independence at discharge. Multivariable analysis was used to identify independent risk factors for each of the outcomes.Overall, 4880 patients were included. ICP monitoring was used in 529 patients (10.8%). Stepwise logistic regression analysis identified ICP monitor placement as an independent risk factor for mortality (OR 1.63; 95% CI 1.28-2.07; p0.001), mechanical ventilation (OR 5.74 95% CI 4.42-7.46; p0.001), ICU length of stay (OR 4.03; 95% CI 2.94-5.52; p0.001), systemic complications (OR 2.78; 95% CI 2.29-3.37; p0.001), and decreased functional independence at discharge (OR 1.71 95% CI 1.29-2.26; p0.001). Subgroup analysis of patients with head AIS 3, 4, and 5 confirmed that ICP monitors remained an independent risk factor for mortality in both head AIS 4 and 5.Compliance with BTF guidelines for ICP monitoring is low, even at level I trauma centers. In this study, ICP monitoring was associated with poor outcomes, and was found to be an independent risk factor for mortality. Further studies are needed to determine the optimal role of ICP monitoring in the management of severe TBI.

Intracranial pressure (ICP) monitoring frequently guides key decisions in the management of diseases causing intracranial hypertension. Although typically measured by invasive means, contraindications may leave the clinician with little recourse for dynamic ICP evaluation—particularly when the patient’s mental status is compromised. We describe here a healthy 18-year-old woman who subacutely progressed to coma due to diffuse cerebral venous sinus thrombosis. Heparinization precluded the use of invasive ICP monitoring, and electroencephalography (EEG) was used novelly as a surrogate ICP monitor. She responded well to anticoagulation and hyperosmolar therapy guided by qualitative EEG and was later discharged with a nearly normal neurologic examination. She was found to have Salmonella bacteremia, heterozygous prothrombin and factor V Leiden mutations, and hemoglobin H disease.

One of the most life-threatening neural conditions is elevated intracranial pressure (ICP); it is associated with ischemia and poor short- and long-term outcomes. Currently, monitoring systems that accurately measure ICP are either highly invasive or inaccurate. This work explores the design and evaluation of an epidural intracranial pressure monitoring system for low-cost, minimally invasive detection. Our goal is to develop a monitoring system that could also be integrated with an electrocorticography (ECoG) system. To this end we created a minimally invasive epidural ICP monitor for use with a 2 mm burr hole craniotomy. A MEMS piezoresistive sensors is used in the system, and its performance is evaluated for intracranial pressure measurements. Our system is calibrated and tested on the benchtop and demonstrated in vivo using an animal model.

Object Intracranial pressure (ICP) monitors are currently based on fluid-filled, strain gauge, or fiberoptic technology. Capacitive sensors have minimal zero drift and energy requirements, allowing long-term implantation and telemetric interrogation; their application to neurosurgery has only occasionally been reported. The aim of this study was to undertake a preliminary in vitro and in vivo evaluation of a capacitive telemetric implantable ICP monitor. Methods Four devices were tested in air- and saline-filled pressure chambers; long-term capacitance-pressure curves were obtained. Devices implanted in a gel phantom and in a piglet were placed in a 3-T MR unit to evaluate MR compatibility. Four devices were implanted in a piglet neonatal hydrocephalus model; output was compared with ICP obtained through fluid-filled transduction and a strain-gauge ICP monitor. Results The capacitance-pressure relationship was constant over 4 weeks, suggesting minimal zero drift during this period. There were no temperature changes around the monitor. Signal loss at the sensor was minimal in both the phantom and the piglet. Over 114,000 measurements were obtained; the difference between mean capacitive ICP and fluid-transduced ICP was 1.8 ± 1.42 mm Hg. The correlation between ICP from the capacitive sensor and fluid-filled transducer (r = 0.97, p < 0.0001) or strain-gauge monitor (r = 0.99, p < 0.0001) was excellent. In vivo monitoring was restricted to 48 hours due to problems with robustness in the clinical environment. Conclusions This preliminary study demonstrates minimal long-term zero drift in vitro, good MR compatibility, and good correlation with other methods of ICP monitoring in vivo in the short term. Further long-term in vivo study is required.

Traumatic brain injury (TBI) is a significant source of morbidity and mortality in the adult population. The management of traumatic brain injury depends on its severity. It must be recognized that almost all forms of treatment for TBI are geared towards the minimization of secondary injury, as it is assumed that primary injury is irreversible. The discussion here represents much of what is known up-to-date concerning TBI management, but its treatment continues to evolve once new mechanisms of injury are discovered and those that we know of now are refined. The treating staffs are encouraged to keep up with the current state of the literature to stay informed.

In patients with severe brain injury, brain edema, elevated intracranial pressure, and cerebral ischemia are accountable for a significant morbidity and mortality. New invasive methods of monitoring attempt to foresee the physiopathological mechanisms responsible for the production of secondary brain injuries. The available methods for monitoring severely brain-injured patients, their potential usefulness, advantages, and disadvantages are reviewed.

The strain-gauge Codman MicroSensor intracranial pressure (ICP) transducer has shown consistently good laboratory performance. To assess the practical performance of the system in patients following acute brain injury, 10 patients were fitted with a MicroSensor and a second ICP monitor. In five cases this was a fibre-optic transducer and in five cases an intraventricular fluid-filled device. Paired ICP values were recorded every 5 min. ICP values ranged from 0 to 31 mmHg. Altman-Bland plots showed that individual readings could differ by as much as 9 mmHg. Further analysis showed that much of this disagreement could be explained by a constant offset on each occasion. Comparison traces of ICP in individual patients show high agreement in timing and size of changes. The unexplained constant offset leads to uncertainty about the true ICP. Treatment decisions are often based upon absolute levels of ICP and patient care may therefore differ depending upon the monitor used.

The aim of this study is the clinical evaluation of the intraparenchymal ICP monitor InnerSpace OPX 100.Sixty-four Inner Space OPX 100 transducers in 51 patients with severe head injury (42), intracranial spontaneous bleeding (6) or hypoxia (3) were studied. The transducer was placed in the frontal white matter. Thirty-nine patients received one catheter, eleven patients two catheters and one patient three catheters. The study period ranged from 10 hours-25 days; total study time was 421.5 days (mean duration 6.6 days).In nine cases (14.1%) an inadequate location of the ICP transducer was found, but the accuracy of the measurement was not influenced. Dislocation of the transducer occurred in eight cases (12.5%) due to inadequate handling. A failed transducer was observed in four cases (6.3%) because of a damaged optical fibre (1) or inadequate handling (3). In one patient (1.9%) a minor local infection developed. In eleven cases (17%) a haematoma around the ICP sensor was observed. Six haematomas were small; five haematomas were larger than 1 cm in diameter. In two patients a large frontal haematoma developed after exchange of the transducer. Operative evacuation was necessary in both cases. Zero shift was below 2 mmHg in all catheters.It is concluded that the InnerSpace intraparenchymal ICP monitor is a reliable device: the rate of catheter related intracerebral haematomas, however, is not acceptable. This could be improved by a better fixation of the catheter in the burr hole in order to avoid micromovements of the transducer.

Objective: Advantages of telemetric devices for long-term ICP measurement have been mentioned several times in the literature. However, descriptions of associated complications are lacking. Therefore, this observational study focuses on clinical and radiological findings after the insertion of an [for full text, please go to the a.m. URL], 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Intracranial pressure monitoring (ICP) is a fundamental component of the modern neurosurgical practice, and its implications for clinical applications must be understood. The indications for ICP monitoring are discussed, and ICP devices and technologies are described. Clinical assessment remains critical in the decision to insert a monitoring device and in analysis of the reported ICP.

Three comparatively priced intracranial pressure (ICP) microtransducers are now available, each characterized by the manufacturer as having very low zero drift over long periods, an excellent frequency response, and a low measurement error. The three microtransducers, coded Transducer A (Camino OLM ICP monitor; Camino Laboratories, San Diego, CA), Transducer B (Codman Microsensor ICP Transducer; CodmanShurtlef Inc., Randolph, MA), and Transducer C (ICP Monitoring Catheter Kit OPX-SD [4F]; InnerSpace Medical, Irvine, CA), were examined in a pressure-flow test rig designed for assessment of hydrocephalus shunts. All three microtransducers compiled with the manufacturers' specifications and gave high-quality readings under test conditions. However, some differences were noted; Transducer C had the lowest 24-hour zero drift (drifts in all transducers were0.8 mm Hg). The temperature drift was very low in Transducer B and C, but Transducer A had a significantly higher drift (0.27 mm Hg/degrees C). Transducer A had a static error0.3 mm Hg, Transducer B2 mm Hg, and Transducer C8 mm Hg. Frequency detection in Transducers A and B were very good (bandwidth,30 Hz), whereas Transducer C had a limited bandwidth of 20 Hz. Transducer B scored the best overall, but all three scored satisfactorily during bench testing.

Background: Hydrocephalus patients are commonly treated by insertion of ventriculoperitoneal shunts, but these have high complication rates. Monitoring of shunt and patient condition can be achieved through measuring intracranial pressure (ICP). Significant zero drift has limited previous developments towards a long-term implantable ICP monitor. We present a new implantable solid-state pressure sensor system appropriate for chronic (lifetime) monitoring of ICP.

A group of 205 patients (115 children and 90 adults) with a total of 212 intracranial pressure (ICP) monitors were retrospectively studied with attention to daily cerebrospinal fluid cultures, duration of monitoring, associated cranial injuries, and hospital site of the ICP monitor (intensive care unit or operating room). Only closed ICP monitoring systems without irrigation or compliance testing were used, and all patients received antibiotics as prophylaxis throughout the monitoring period. There were no complications associated with monitor placement. Incidence histograms and regression analysis were used to determine the daily risk of subsequent infections, in addition to evaluating the cumulative risk of infection, as has been previously described in the literature. No relation between the duration of ICP monitoring and the rate of daily infection through the period of maximal monitoring (1-2 weeks) was found in this series. The overall incidence of infection was 7.1% with a median duration of monitoring of 7.2 days. The age of the patient (adult vs. child), site of ICP monitor placement, and nature of the underlying disease (trauma vs. nontrauma) had no significant effect on the development of monitor-related infections in our study. These data indicate that the decision to continue ICP monitoring can be based solely on the clinical necessity for further monitoring rather than on concerns for monitor removal to prevent infection.

Intracranial pressure monitoring (ICP) is a technology that assists critical care nurses in the assessment, planning, intervention, and evaluation of care. The physiologic basis of intracranial hypertension (ICH) and ICP monitoring are reviewed. Types of monitors arc described. Advantages, disadvantages, and complications of fluid-filled versus fiberoptic systems are explored. Priorities in nursing care of the patient with an ICP monitor are examined

Invasive intracranial-pressure monitoring is often used in patients with suspected increases in intracranial pressure, especially those with traumatic brain injury. This video describes the insertion of an intraparenchymal ICP monitor.

Continuous intracranial pressure (ICP) monitoring is performed in selected patients with hydrocephalus to determine whether shunt placement is required. The mean ICP is usually calculated from end-hour readings manually recorded by nurses. The aim of this study was to evaluate the accuracy of manual recordings by comparing nurses' end-hour ICP readings with those of an online computerized ICP monitoring system that records one ICP value per second.Continuous ICP monitoring was performed using a fiberoptic extradural sensor in 115 patients with hydrocephalus of different origins. A notebook computer was connected to an ICP monitor and was programmed to register one ICP value per second. In all patients, mean ICP values were calculated from data recorded manually by nurses at the end of every hour and from data recorded by the computer within the preselected time period. The two methods were compared using correlation analysis and the Bland and Altman method. The median number of ICP values noted manually by the nurses in each patient was 17 (interquartile range 15-18 readings), and that recorded by the software was 61,200 (interquartile range 54,000-64,800 readings). The correlation coefficient of the mean ICP values recorded by both methods was r = 0.99 (p0.001). The Bland and Altman analysis revealed a mean difference of 0.3 +/- 1.26 mm Hg between the two methods and that they were equally valid with all mean ICP values.The recording of end-hour ICP values by nurses is an accurate method of calculating the mean ICP after prolonged ICP monitoring in patients with hydrocephalus.

Object: We wished to find a way of monitoring patients' intracranial pressure (ICP) during endoscopic surgery. Methods: The Codman Microsensor ICP monitor can be inserted through the working channel of an endoscope with an interposed assembly (Check Flo II with male fitting, 9 F, manufactured by Cook, model #CFM-100TM) to provide a water-tight seal and allow simultaneous irrigation. During endoscopic third ventriculostomy surgery with this setup in our hospital, the ICP was continuously monitored. The effects of irrigation on ICP were also followed. The sensor was assumed to be absolutely accurate and not referenced to a column of water. Conclusion: The small size of the Microsensor ICP monitor enabled easy placement through the working channel of the endoscope and interposed assembly. The ICP reading was continuously available, even during irrigation. The effect of irrigation on ICP was carefully monitored, and limited when pressure changes were noted.

The fibreoptic device is a type of intracranial pressure monitor which seems to offer certain advantages over conventional monitoring systems. This study was undertaken to analyse the accuracy, drift characteristics, and complications of the Camino fibreoptic device.One hundred and eight Camino intracranial pressure (ICP) devices, in their three modalities, were implanted during 1997. The most frequent indication for monitoring was severe head injury due to road traffic accidents.Sixty eight probe tips were cultured; 13.2% of the cases had a positive culture without clinical signs of infection, and 2.9% had a positive culture with clinical signs of ventriculitis. The most common isolated pathogen was Staphylococcus epidermidis. All patients were under cephalosporin prophylaxis during monitoring. Haemorrhage rate in patients without coagulation disorders was 2.1% and 15.3% in patients with coagulation abnormalities. Drift characteristics were studied in 56 cases; there was no drifting from the values expected according to the manufacturer's specifications in 34 probes. There was no relation between direction of the drift and duration of placement, nor between drift and time.Although the complication and drift rates were similar to those reported elsewhere, there was no correlation between the direction of the drift and long term monitoring despite the fact that some published papers refer to overestimation of values with time with this type of device.

Thermal diffusion flowmetry is a continuous quantitative technique of measuring regional cerebral blood flow utilizing a silastic strip probe placed through a craniotomy or craniectomy in the operating room. A new bolt like application of this technology is now available for commercial use and is especially designed for bedside placement in trauma patients. This new trauma bolt is tested in juvenile pigs who are subjected to episodes of hypercapnea to increase cerebral blood flow, and records significant changes in blood flow. Another feature of the trauma bolt is a second port for the placement of an intracranial pressure (ICP) monitor. Placement of the probe and ICP monitor were easier than with the silastic probe and had relatively little complication.

✓ A No. 4 French fiberoptic catheter initially developed as an intravascular pressure sensor was incorporated into a system to be used as an intracranial pressure (ICP) monitor. Initially, a series of acute and chronic animal experiments carried out in the rabbit and pig, respectively, demonstrated the reliability and safety of the device. Subsequently, this new monitor was compared to a concurrently functioning ICP monitor in 15 adult and five pediatric patients. This clinical experience also confirmed the safety, accuracy, and reliability of the device. Since these initial studies, this monitor has been used to routinely measure ICP in a large number of adult and pediatric patients. The monitor has functioned well, and there have been no complications related to its use except for an occasional problem with breakage of the optic fiber as a result of patient movement or nursing maneuvers, which has been easily corrected by replacement of the probe. As nursing personnel and ancillary services have become familiar with this new monitor, breakage has not been a problem. This new device can be placed into the ventricular system, the brain parenchyma, or the subdural space, and appears to offer substantial advantages over other monitors presently in use.

The Fiber Optic Transducer (FOT) ICP monitor is an electrically safe microprocessor driven system which employs a non-electrical pressure sensor. It monitors ICP in a range of –6 to 250 mmHg, with a frequency response of 100 Hz or higher. The FOT device is based on a breakthrough in fiberoptic technology which allows information to be transmitted through a single optical fiber of about 50 µm in diameter. The sensing unit, which gives a direct readout of pressure, can be made small enough to pass through a 17 gauge needle (1.5 mm diameter).

We treated a brain-damaged 8-month-old male with iv doxapram in order to discontinue mechanical ventilation. We were able to monitor intracranial pressure (ICP) throughout the course of doxapram via an ICP monitor. Despite normal and then excessive PaCO2, the patient's spontaneous respiratory rate remained nil before doxapram treatment. However, after an iv bolus dose followed by a maintenance drip, the patient's spontaneous respiratory rate increased while his ICP remained at baseline or slightly less than baseline, thereby allowing mechanical ventilation to be discontinued.

The intracranial pressure of 12 infants, birthweight 720-1800 gms., who had no evidence of intracranial hemorrhage, was measured over the anterior fontanelle by the Ladd ICP monitor. Pressures were determined before and one minute after the release of encircling phototherapy eye patches or nasal cannula apparatus. The measurements were performed twice on each infant in three different positions -- head up 30°, horizontal, and head down 30°. A significant decrease in pressure was noted immediately after release of the encircling band in all three positions in most infants. The average decrease was 3.75 (range 0-14.5), 3.73 (range 0-10), and 3.45 (range 0-9) cm H2O in the head up, horizontal, and head down position respectively. Three of the four infants who demonstrated the smallest decrease in intracranial pressure had been exposed to constricting apparatus for long periods of time prior to their determinations suggesting possible compensation. The magnitude of the decrease in pressure was not different in the various positions studied, although the pressures tended to increase as the infant was placed in the head down position. The changes noted in intracranial pressure both with positioning and banding raise questions as to the effect of such infant care practices on the brain of infants with compressible skulls. Increases in intracranial pressure induced by head banding may play a role in the high incidence of intracranial hemorrhage in the very small infant.

We retrospectively reviewed intracranial pressure (ICP) monitors to determine whether infectious complications occur most frequently at the time of monitor insertion, or increase with duration of monitoring. Seventy two ICP monitors in 65 children with acute brain injuries were reviewed. Monitoring was carried out for 7 days or longer in more than half the cases (range 1–28 days). Nine infections (positive monitor surveillance cultures) occurred on days 2–11. The risk of a subsequent infection rose from an initial 1.5 infections/100 subsequent monitor-days to a high of 1.9 infections/100 subsequent monitor-days on day 6, and progressively diminished after day 6. For monitors remaining in place and uninfected, the percent with a subsequent infection was highest in the first 2 days and diminished thereafter. If a distinction is made between monitor colonization (positive monitor surveillance culture, patient afebrile, no CSF pleocytosis) vs. patient infection (fever, CSF pleocytosis), only 8.3% of monitors overall, and only 4.9% of monitors in non-craniotomy patients caused infection. These observations suggest that introduction of infection occurs at the time of monitor insertion. Routine reinsertion of a new monitor might increase risk by re-exposing the patient to contamination at the time of insertion. An indwelling ICP monitor should be used as long as necessary with reinsertion of a new monitor only if a malfunction or positive surveillance culture occurs.