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Intervention Review

Routine intracranial pressure monitoring in acute coma

  1. Rob J Forsyth1,*,
  2. Beryl Rodriguez2

Editorial Group: Cochrane Injuries Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 31 MAR 2006

DOI: 10.1002/14651858.CD002043

Database Title

Additional Information

How to Cite

Forsyth RJ, Rodriguez B. Routine intracranial pressure monitoring in acute coma. Cochrane Database of Systematic Reviews 2001, Issue 3. Art. No.: CD002043. DOI: 10.1002/14651858.CD002043.

Author Information

  1. 1

    University of Newcastle upon Tyne, School of Clinical Medical Sciences (Child Health), Newcastle upon Tyne, Tyne & Wear, UK

  2. 2

    North Tyneside General Hospital, Department of Paediatrics, North Shields, UK

*Rob J Forsyth, School of Clinical Medical Sciences (Child Health), University of Newcastle upon Tyne, Royal Victoria Infirmary, Newcastle upon Tyne, Tyne & Wear, NE1 4LP, UK. r.j.forsyth@newcastle.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Studies in traumatic encephalopathy first led to the insight that the damage seen was not just due to direct consequences of the primary injury. A significant, and potentially preventable, contribution to the overall morbidity arose from secondary hypoxic-ischaemic damage. Brain swelling accompanied by raised intracranial pressure (ICP) resulted in inadequate cerebral perfusion with well-oxygenated blood. Detection of raised ICP could be useful in alerting clinicians to the need to improve cerebral perfusion, with consequent reductions in brain injury.

Objectives

To determine whether routine ICP monitoring in all acute cases of severe coma reduces the risk of all-cause mortality or severe disability at final follow-up.

Search strategy

We searched the Cochrane Injuries Group's specialised register, CENTRAL, MEDLINE, EMBASE and the Index of Scientific and Technical Proceedings. We also checked the reference lists of all relevant articles. The searches were last updated in April 2006.

Selection criteria

All randomised controlled studies of real-time ICP monitoring by invasive or semi-invasive means in acute coma (traumatic or non-traumatic aetiology) versus no ICP monitoring (that is, clinical assessment of ICP).

Data collection and analysis

Primary outcome measures were all-cause mortality and severe disability at the end of the follow-up period.

Main results

No studies meeting the selection criteria have been identified to date.

Authors' conclusions

There are no data from randomised controlled trials that can clarify the role of ICP monitoring in acute coma.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

No evidence from trials to show the effects of routine monitoring of intracranial pressure following head injury

The brain is situated in a rigid box (the skull) that cannot expand, so normal swelling from injury cannot occur. When brain swelling does occur, pressure inside the skull rises. This makes it harder for the heart to pump the oxygen and blood into the brain needed for recovery. If this swelling is not controlled, further brain damage is caused. Efforts to avoid this damage can include routine monitoring of the pressure inside the skull (intracranial). The review of trials found no evidence to show the effects of routine measurement of pressure in the skull. More research is needed.

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