Intracranial Pressure Monitoring Devices and Protocols

Device Recommendations

The American College of Critical Care Medicine recommends using external ventricular catheters (EVD) and parenchymal ICP monitors for measuring intracranial pressure, with EVDs being preferred in cases of hydrocephalus when safe and practical to place 1
External ventricular catheters (EVD) are considered the gold standard for ICP monitoring and provide the most reliable and accurate measurements, allowing for therapeutic CSF drainage for ICP management, as recommended by the European Society of Intensive Care Medicine 1, 2
Parenchymal ICP monitors are equally accurate for pressure measurement but do not allow for CSF drainage, and are preferred when ventricular access is difficult or contraindicated, according to the Brain Injury Foundation 1, 2

Patients with hydrocephalus or significant intraventricular hemorrhage should be considered for EVD placement, as suggested by the Neurocritical Care Society 1
When CSF drainage may be needed as part of treatment, EVDs are the preferred choice, as recommended by the American Heart Association 2
Standard insertion and maintenance protocols should be used to ensure safety and reliability of ICP monitoring procedures, according to the World Federation of Neurosurgical Societies 1
Before insertion of any monitoring device, the patient's coagulation status should be evaluated, and prior use of antiplatelet agents may justify platelet transfusion, as recommended by the American College of Chest Physicians 2

ICP monitoring should be tailored to the specific diagnosis, such as subarachnoid hemorrhage, traumatic brain injury, or encephalitis, as suggested by the European Society of Intensive Care Medicine 1
While refractory ICP elevation strongly predicts mortality, ICP measurements should not be used in isolation as a prognostic marker for functional outcomes, according to the Brain Injury Foundation 1
ICP monitoring is a mandatory prerequisite when other intracranial monitors are used, providing a framework for optimal interpretation of additional monitoring data, as recommended by the Neurocritical Care Society 3

Invasive ICP monitoring carries risks including infection and intracranial hemorrhage, with a higher risk associated with ventricular catheters than with parenchymal devices, as reported by the American Heart Association 2
The risk of hemorrhage or infection is generally higher with ventricular catheters than with parenchymal devices, although these rates are primarily derived from traumatic brain injury or subarachnoid hemorrhage data, according to the Stroke Association 2