Routine intracranial pressure monitoring in acute coma (Cochrane Review)

A substantive amendment to this systematic review was last made on 05 March 2001. Cochrane reviews are regularly checked and updated if necessary.

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.

Objectives: 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.

Search strategy: MEDLINE, EMBASE and the Injury Group's trial registry were searched (see below for full strategy). Reference lists of all relevant articles and review articles were also checked. Additionally the Index of Scientific and Technical Proceedings was also searched using "intracranial pressure" as keyword.

Selection criteria: 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 (i.e. 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.

Main results: No studies meeting the selection criteria have been identified to date

Reviewers' conclusions: There are no data from randomised controlled trials that can clarify the role of ICP monitoring in acute coma.

Citation: Forsyth RJ, Baxter P, Elliott T. Routine intracranial pressure monitoring in acute coma (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

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This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

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