ICP monitoring is now a common clinical practice that serves as a diagnostic tool for people with chronic neurological diseases as well as a cornerstone in the surveillance of patients with acute brain injury or disease. With a CAGR of 6.2 per cent, the market for intracranial pressure monitoring devices is anticipated to increase from USD 1.3 billion in 2020 to USD 2.37 billion in 2030. For non-invasive and less invasive ICP measurements, it is crucial to managing the quality of the ICP source signal.
The constant monitoring of intracranial pressure (ICP) is widely regarded as being essential to the care and diagnosis of neurological and neurosurgical patients. Some aspects of ICP monitoring, including the clinical indications for ICP, the relevance of ICP in predicting the clinical outcome of diseases or treatment regimens, the clinical utility of the many ICP metrics, and the most appropriate method for measuring ICP, are still up for debate. Even though clinical practice as we know it has changed over the past 60 years, the argument still exists.
The pathophysiological justification for ICP measurement
The solid nature of the skull, which prevents the increase in the total volume of the intracranial content, provides the pathophysiological basis for measuring ICP. The parenchyma of the CNS or central nervous system, cerebrospinal fluid (CSF), and blood (arterial and venous) are the primary components of the intracranial compartment. The total volume of parenchyma, CSF, and blood is constant, says the Monro-Kellie theory. Therefore, a volume gain in any of these components or additional expansions (such as bleeds or tumours) must be offset by a volume decrease in the parenchyma, CSF, and/or blood. ICP measurement is used to evaluate how intracranial volume changes affect the intracranial state.
Pressure gradients may be produced by intracranial pathology such as mass lesions from traumatic brain injury (TBI). The herniation of brain tissue relative to the meninges due to pressure gradients may limit blood flow or harm due to direct pressure on central nervous system structures. For instance, pressure to the midbrain or brainstem may have fatal effects on consciousness and vital processes (respiratory and cardiovascular failure). Thus, avoiding the effects of brain herniation is one justification for ICP monitoring.
The current practice of carrying out ICP
The clinical practice of measuring ICP nowadays varies significantly between centres around the globe, however, certain general patterns can be found.
The primary focus of ICP monitoring is the observation of patients receiving care in a neuro-intensive care unit. Many people view this modality as the foundation for the supervision of critically ill patients in these centres. Patients that receive ICP monitoring can be split, broadly speaking, into three groups. First, and most frequently, are those with TBI, where it was discovered that the average ICP in the first 48 hours after TBI was a reliable indicator of death and functional prognosis at six months. Second, ICP has a position in neuro-intensive surveillance of non-TBI patients, such as those with central nervous system (CNS) infections and cerebral bleeds, including subarachnoid haemorrhage (SAH) and spontaneous intracerebral bleeding with mass effect. Systemic illnesses such as acute liver failure, end-stage kidney failure, and hypertensive encephalopathy may also be monitored as part of non-TBI surveillance. Thirdly, some hospitals employ ICP measurements to diagnose patients with hydrocephalus (communicating hydrocephalus, idiopathic normal pressure hydrocephalus), idiopathic intracranial hypertension, and Chiari malformation, among other subacute or chronic health conditions connected to CSF problems.
