ICU Vivas · Raised ICP & TBI
Equipment viva — the intracranial-pressure monitor, the external ventricular drain and the ICP waveform
An equipment viva on the hardware and physics of intracranial-pressure monitoring — intraparenchymal versus intraventricular catheters, the zeroing of an external ventricular drain at the foramen of Monro, and the three-component ICP waveform and what a rising P2 wave tells you about intracranial compliance.
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Stimulus
You are shown a schematic of an intracranial-pressure monitoring system. Two catheter options are depicted: an intraparenchymal transducer (a fibre-optic or piezoelectric sensor placed directly into the brain substance) and an external ventricular drain (a catheter placed into the lateral ventricle and connected to an external pressure transducer and a collection chamber). Beside it is a normal intracranial-pressure waveform with three peaks labelled P1, P2 and P3, and the drainage chamber is shown levelled to the external auditory meatus.
References3ShowHide
- [1]Carney N, Totten AM, O'Reilly C, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery, 2017.PMID 27654000
- [2]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [3]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.