TY - JOUR

T1 - Noninvasive intracranial pressure monitoring in central nervous system infections

AU - Wolthers, Signe A.

AU - Engelholm, Cecilie P.

AU - Uslu, Bülent

AU - Brandt, Christian T.

N1 - Publisher Copyright: © 2022 THE AUTHORS.

PY - 2023

Y1 - 2023

N2 - Intracranial pressure (ICP) monitoring constitutes an important part of the management of traumatic brain injury. However, its application in other brain pathologies such as neuroinfections like acute bacterial meningitis is unclear. Despite focus on aggressive, prompt treatment, morbidity and mortality from acute bacterial meningitis remain high. Increased ICP is well-known to occur in severe neuroinfections. The increased ICP compromise cerebral perfusion pressure and may ultimately lead to brain stem herniation. Therefore, controlling the ICP could also be important in acute bacterial meningitis. However, risk factors for complications due to invasive monitoring among these patients may be significantly increased due to higher age and levels of comorbidity compared to the traumatic brain injury patient from which the ICP treatment algorithms are developed. This narrative review evaluates the different modalities of ICP monitoring with the aim to elucidate current status of non-invasive alternatives to invasive monitoring as a decision tool and eventually monitoring. Non-invasive screening using ultrasound of the optical nerve sheath, transcranial doppler, magnetic resonance imaging or preferably a combination of these modalities, provides measurements that can be used as a decision guidance for invasive ICP measurement. The available data do not support the replacement of invasive techniques for continuous ICP measurement in patients with increased ICP. Non-invasive modalities should be taken into consideration in patients with neuroinfections at low risk of increased ICP.

AB - Intracranial pressure (ICP) monitoring constitutes an important part of the management of traumatic brain injury. However, its application in other brain pathologies such as neuroinfections like acute bacterial meningitis is unclear. Despite focus on aggressive, prompt treatment, morbidity and mortality from acute bacterial meningitis remain high. Increased ICP is well-known to occur in severe neuroinfections. The increased ICP compromise cerebral perfusion pressure and may ultimately lead to brain stem herniation. Therefore, controlling the ICP could also be important in acute bacterial meningitis. However, risk factors for complications due to invasive monitoring among these patients may be significantly increased due to higher age and levels of comorbidity compared to the traumatic brain injury patient from which the ICP treatment algorithms are developed. This narrative review evaluates the different modalities of ICP monitoring with the aim to elucidate current status of non-invasive alternatives to invasive monitoring as a decision tool and eventually monitoring. Non-invasive screening using ultrasound of the optical nerve sheath, transcranial doppler, magnetic resonance imaging or preferably a combination of these modalities, provides measurements that can be used as a decision guidance for invasive ICP measurement. The available data do not support the replacement of invasive techniques for continuous ICP measurement in patients with increased ICP. Non-invasive modalities should be taken into consideration in patients with neuroinfections at low risk of increased ICP.

KW - Central nervous system

KW - Infections

KW - Intracranial pressure

KW - Meningitis

U2 - 10.23736/S0375-9393.22.16863-X

DO - 10.23736/S0375-9393.22.16863-X

M3 - Review

C2 - 36422116

AN - SCOPUS:85150000594

VL - 89

SP - 206

EP - 216

JO - Minerva Anestesiologica

JF - Minerva Anestesiologica

SN - 0375-9393

IS - 3

ER -