Intracranial pressure monitoring device

Placement of Intracranial Pressure Monitors by Nonneurosurgeons: Good Outcomes are Achieved

Authors: Marcus A Barber, MD, Stephen D Helmer, PhD, Jonathan TMorgan, DO, James M Haan, MD.

Invited Discussant: J. Wayne Meredith

Introduction: Traumatic Brain Injury remains one of the most prevalent and costly injuries encountered. Traditionally, neurosurgeons have placed intracranial pressure (ICP) monitors. However, neurosurgery coverage problems may result in delayed placement. This study sought to confirm ICP monitors may be safely inserted by non-neurosurgeons. Methods: A 10-year retrospective review of ICP placements at a Level 1 Trauma Center. Results represent demographic variables, the incidence of complications between monitors placed by general surgical residents, trauma surgeons and neurosurgeons, and mortality. Results: Patients in this study totaled 557. Average age, hospital length of stay and injury severity score were 38.2 + -  22.3 yrs., 15.9 + - 19.1 days and 27.6 + - 11.6, respectively. The majority of patients were male (71.6%), and injured in motor vehicle crashes (51.5%), or falls (20.1%). The majority of ICP monitors were placed by residents under trauma attending supervision (83.3%), neurosurgeons (11.3%), and trauma surgeons (5.4%). One CNS infection occurred in a patient treated by a resident. Type of physician placing the monitor had no effect on complications. Of the three patients with iatrogenic bleed, no morbidity or mortality was attributed to monitor placement.

Two-depth transcranial Doppler: a novel approach for non-invasive absolute intracranial pressure measurement

Authors: Nusbaum DM. (Baylor College of Medicine, Department of Medicine, USA.)

There is a real need in healthcare for a way to rapidly yet safely measure intracranial pressure. The two-depth transcranial Doppler technology shows promise in its ability to measure ICP non-invasively, with accuracy and without the need for individual calibration. With time and improvement, this technology may prove valuable in multiple settings, including aviation, space, and emergency medicine.

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