No definite threshold for CPP has been established for pediatric TBI patients, but the guidelines suggest maintaining a CPP of 40-65. In addition to its effect on CPP, extremely elevated ICP can lead to brain herniation and death.
Clinical signs of increased ICP include:
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The literature does support the use of ICP monitors in severe TBI. There are 2 types of ICP monitors that can be used. An intraventricular catheter attached to an external strain gauge is the preferred method of measuring ICP. It has the added advantage of allowing CSF drainage as treatment for increased ICP. However, with an edematous brain and small, collapsed ventricles, it may not be possible to insert such a catheter. The other type of ICP monitor is a fiberoptic or catheter tip strain gauge transducer which is inserted either into the subarachnoid space or the brain parenchyma. CSF cannot be drained through these catheters nor can they be recalibrated after insertion.
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