Intracranial pressure monitoring in patients with severe head injury

Increased intracranial pressure (ICP) has an adverse effect on the clinical course of patients with severe head injuries. Direct intracranial measurement is the only method of knowing the precise ICP. At the Maryland Institute for Emergency Medical Services Systems, elevations in ICP are treated according to an aggressive protocol. Our experience with this protocol has led to the following conclusions: 1) ICPs above 25 mm Hg are associated with an unacceptable mortality, 2) aggressive medical treatment of patients with an ICP of 16 mm Hg can decrease the number of patients whose ICPs reach 25 mm Hg, and 3) the overall mortality of severe head injury can be reduced with such a protocol. ICP monitoring can be a valuable parameter in the management of severe head injury. With continuous accurate reading of ICP, sound theraputic decisions can be made about the patient's care that, ultimately, can effect the patient's survival and outcome.