Bedside burr hole for intracranial pressure monitoring performed by intensive care physicians. A 5-year experience.
OBJECTIVE
To assess the results of a 5-year experience with bedside burr hole for intracranial pressure (ICP) monitoring performed by intensive care physicians.


METHODS
Prospective, observational study in 120 patients.


METHODS
A general-neurologic Intensive Care Unit in a University Hospital.


METHODS
Patients admitted for acute neural lesion requiring ICP monitoring.


METHODS
A 2.71 mm burr hole was made with positioning of a subarachnoid screw, through which a miniaturized fiberoptic, tip transducer device (Camino) was advanced and inserted 2 mm in the frontal cortex.


RESULTS
Over a 5-year period 120 patients, mainly with severe head trauma, underwent ICP monitoring. None of the planned patients was excluded because of technical difficulties. No life-threatening complications were reported, and the overall morbidity rate related to the ICP monitor was 3.3%. Complications were infectious in nature, with 2.5% wound infections and 0.8% meningitis. Although seven patients bled when opening the dura, no intracranial hematomas were recorded due to the ICP monitor. The fiberoptic device was left in place for 5 +/- 1.6 (SD) days (range 1-12 days). Five patients (4.1%) required catheter substitution due to breakage of the system components (fiberoptics).


CONCLUSIONS
Bedside insertion of a ICP monitor performed by intensive care physicians is a safe procedure, with a complication rate comparable to other series published by neurosurgeons. The overall morbidity rate is comparable to, or even lower than, that caused by central vein catheterization.
Bochicchio
M
M
Institute of Anesthesiology-Intensive Care, Brescia, Italy.
Latronico
N
N
Zappa
S
S
Beindorf
A
A
Candiani
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D003422:Critical Care / Q000379:methods*; D004868:Equipment Failure; D005336:Fiber Optic Technology; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D007427:Intracranial Pressure; D007558:Italy; D008505:Medical Staff, Hospital; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies; D013997:Time Factors