Non-invasive intracranial pressure assessment in adult critically ill patients: A narrative review on current approaches and future perspectives

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-08-23 DOI:10.1016/j.jclinane.2025.111977

Cristian Deana , Daniele Guerino Biasucci , Raffaele Aspide , Daniele Bagatto , Sergio Brasil , Domenico Brunetti Jr , Thomas Saitta , Mina Vapireva , Christian Zanza , Yaroslava Longhitano , Elena Giovanna Bignami , Luigi Vetrugno

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引用次数: 0

Abstract

Intracranial hypertension (IH) is a life-threatening complication that may occur after acute brain injury. Early recognition of IH allows prompt interventions that improve outcomes. Even if invasive intracranial monitoring is considered the gold standard for the most severely injured patients, scarce availability of resources, the need for advanced skills, and potential for complications often limit its utilization. On the other hand, different non-invasive methods to evaluate acutely brain-injured patients for elevated intracranial pressure have been investigated. Clinical examination and neuroradiology represent the cornerstone of a patient's evaluation in the intensive care unit (ICU). However, multimodal neuromonitoring, employing widely used different tools, such as brain ultrasound, automated pupillometry, and skull micro-deformation recordings, increase the possibility for continuous or semi-continuous intracranial pressure monitoring.

Furthermore, artificial intelligence (AI) has been investigated to as a tool to predict elevated intracranial pressure, shedding light on new diagnostic and treatment horizons with the potential to improve patient outcomes.

This narrative review, based on a systematic literature search, summarizes the best available evidence on the use of non-invasive monitoring tools and methods for the assessment of intracranial pressure.

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成人危重患者无创颅内压评估：对当前方法和未来前景的叙述回顾

颅内高压（IH）是急性脑损伤后可能发生的危及生命的并发症。早期发现IH可以及时采取干预措施，改善结果。即使侵入性颅内监测被认为是最严重损伤患者的金标准，但资源的稀缺、对先进技术的需求以及潜在的并发症往往限制了其应用。另一方面，研究了不同的非侵入性方法来评估急性脑损伤患者颅内压升高。临床检查和神经放射学是重症监护病房（ICU）患者评估的基石。然而，多模式神经监测，采用广泛使用的不同工具，如脑超声、自动瞳孔测量和颅骨微变形记录，增加了连续或半连续颅内压监测的可能性。此外，人工智能（AI）已被研究作为预测颅内压升高的工具，揭示了新的诊断和治疗视野，并有可能改善患者的预后。这篇叙述性综述，基于系统的文献检索，总结了使用无创监测工具和方法评估颅内压的最佳证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.