Intracranial pressure monitoring.

Brain injury is the result of both primary and secondary damage, yielded by a complex range of factors including ischemia, biochemical changes and inflammatory cascade. Secondary brain injury may be caused by systemic or intracranial mechanisms including oligaemia due to low cerebral perfusion pressure (CPP) or increased cerebral vascular resistance (vascular distortion or cerebro-vascular narrowing), hypoxemia (airway obstruction, pulmonary pathology or anaemia), intracranial hypertension and changes of brain metabolic rate. Furthermore, secondary insults cause tissue damage according to their nature, severity and duration,making their early detection and correction an essential step ofmanagement. Several neuroprotective agents have been introduced in the past two decades, but, despite their potential effectiveness, the results have been disappointing; therefore, the current basis for prevention of secondary brain damage remains prevention and correction of secondary insults. While nowadays several techniques are available for monitoring severely head-injured patients, monitoring intracranial pressure (ICP) still plays a key role, providing essential information for further decision making.