Evolving concepts in intracranial pressure monitoring - from traditional monitoring to precision medicine

Rohan Mathur; Lin Cheng; Josiah Lim; Tej D Azad; Peter Dziedzic; Eleanor Belkin; Ivanna Joseph; Bhagyashri Bhende; Sudha Yellapantula; Niteesh Potu; Austen Lefebvre; Vishank Shah; Susanne Muehlschlegel; Julian Bosel; Tamas Budavari; Jose I Suarez

doi:10.1016/j.neurot.2024.e00507

Evolving concepts in intracranial pressure monitoring - from traditional monitoring to precision medicine

Neurotherapeutics. 2025 Jan 2:e00507. doi: 10.1016/j.neurot.2024.e00507. Online ahead of print.

Authors

Rohan Mathur¹, Lin Cheng², Josiah Lim³, Tej D Azad⁴, Peter Dziedzic⁵, Eleanor Belkin⁶, Ivanna Joseph⁷, Bhagyashri Bhende⁸, Sudha Yellapantula⁹, Niteesh Potu¹⁰, Austen Lefebvre¹¹, Vishank Shah¹², Susanne Muehlschlegel¹³, Julian Bosel¹⁴, Tamas Budavari¹⁵, Jose I Suarez¹⁶

Affiliations

¹ Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
² Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
³ Department of Applied Mathematics and Statistics, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA. Electronic address: [email protected].
⁴ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
⁵ Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
⁶ Department of Applied Mathematics and Statistics, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA. Electronic address: [email protected].
⁷ Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
⁸ Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
⁹ Medical Informatics Corporation, Houston, TX, USA. Electronic address: [email protected].
¹⁰ Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
¹¹ Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
¹² Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
¹³ Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
¹⁴ Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany. Electronic address: [email protected].
¹⁵ Department of Applied Mathematics and Statistics, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA. Electronic address: [email protected].
¹⁶ Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].

PMID: 39753383
DOI: 10.1016/j.neurot.2024.e00507

Abstract

A wide range of acute brain injuries, including both traumatic and non-traumatic causes, can result in elevated intracranial pressure (ICP), which in turn can cause further secondary injury to the brain, initiating a vicious cascade of propagating injury. Elevated ICP is therefore a neurological injury that requires intensive monitoring and time-sensitive interventions. Patients at high risk for developing elevated ICP undergo placement of invasive ICP monitors including external ventricular drains, intraparenchymal ICP monitors, and lumbar drains. These monitors all generate an ICP waveform, but each has its own unique caveats in monitoring and accuracy. Current ICP monitoring and management clinical guidelines focus on the mean ICP derived from the ICP waveform, with standard thresholds of treating ICP greater than 20 mmHg or 22 mmHg applied broadly to a wide range of patients. However, this one-size fits all approach has been criticized and there is a need to develop personalized, evidence-based and possibly multi-factorial precision-medicine based approaches to the problem. This paper provides historical and physiological context to the problem of elevated ICP, provides an overview of the challenges of the current paradigm of ICP management strategies, and discusses advances in ICP waveform analysis, emerging non-invasive ICP monitoring techniques, and applications of machine learning to create predictive algorithms.

Keywords: Acute brain injury; External ventricular drain; History; ICP prediction; Intracranial pressure; Machine learning.

Publication types

Review