Role of intracranial pressure monitoring in head injury - A prospective study

Intra-cranial pressure (ICP) monitoring was carried out in 51 patients with head injury, admitted to the intensive care unit of All India Institute of Medical Sciences for a minimum of 24 hours, 74% patients with mass lesion and 33 % patients without mass lesion had raised ICP (<15 mm of Hg). CT scan was not always reflective of ICP status. ICP monitoring helped in avoiding unnecessary mannitol therapy in 8 out of 12 patients without mass lesion, In this group presence or absence of raised ICP did not affect the outcome. Among 21 patients with mass lesions initially managed conservatively, 3 were operated upon on the basis of raised ICP alone, Four patients with good Glasgow Coma Sclae (GCS) (11-14), who had raised ICP were operated after clinical deterioration. However, in these patients raised ICP preceded clinical deterioration by 8-12 hours. In electively ventilated patients, raised ICP guided early repeat scan and early detection of postoperative haematomas, Patients with mass lesion and increasing ICP had poor outcome, overall mortality being 41%, Among them 48% died due to raised ICP. Damped tracings or blockage of device were the most common complications of ICP monitoring. This complication was recorded in 25% of cases in whom Richmond screw was used and 12% of cases in whom intra-cavitary catheter was used. Six percent cases developed meningitis.