Routine intracranial pressure monitoring in acute coma.
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.


OBJECTIVE
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.


METHODS
We searched MEDLINE, EMBASE, The Injuries Group's specialised register and the reference lists of all relevant articles and review articles. In addition we searched the Index of Scientific and Technical Proceedings using "intracranial pressure" as keyword.


METHODS
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 (ie 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.


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


CONCLUSIONS
There are no data from randomised controlled trials that can clarify the role of ICP monitoring in acute coma.
Forsyth
R
R
Department of Child Health, University of Newcastle upon Tyne, Department of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, Tyne & Wear, UK, NE1 4LP. r.j.forsyth@newcastle.ac.uk
Baxter
P
P
Elliott
T
T
D000208:Acute Disease; D001930:Brain Injuries / Q000150:complications; D002560:Cerebrovascular Circulation; D003128:Coma / Q000503:physiopathology*; D006801:Humans; D019586:Intracranial Hypertension / Q000503:physiopathology*; D007427:Intracranial Pressure / Q000502:physiology; D008991:Monitoring, Physiologic