Evidenced Based Clinical Review: Intracranial Monitoring, Brain Tissue Oxygen Monitoring, Bispectral Monitoring-AANN23_ICP_EBCR

AANN23_ICP_EBCR_FINAL

Pdf Summary

The American Association of Neuroscience Nurses’ 2023 evidence-based clinical review examines intracranial pressure (ICP), brain tissue oxygen (PbtO₂), and bispectral index (BIS) monitoring in patients with acute neurological injury. It synthesizes research published from 2010–2020, but the heterogeneous and often limited evidence prevents definitive, evidence-based bedside recommendations.<br /><br />Neurological monitoring is relevant in conditions including traumatic brain injury, hemorrhagic or severe ischemic stroke, hydrocephalus, and status epilepticus. Serial assessments—such as level of consciousness, pupils, motor and sensory function, and appropriate tools like the GCS, FOUR Score, or NIHSS—help detect deterioration.<br /><br />External ventricular drains (EVDs) both measure ICP and drain cerebrospinal fluid; intraparenchymal monitors measure pressure but cannot drain fluid. Evidence does not establish one device as consistently superior for outcomes. EVDs may have higher infection and complication rates, while antimicrobial- or silver-impregnated catheters and bundled insertion and maintenance protocols may reduce infection. Optimal catheter duration, placement, zeroing landmarks, and care practices remain uncertain. When precise ICP readings are needed, a clamped EVD is generally more reliable than an open, continuously draining system. Device care should follow institutional protocols and manufacturer guidance.<br /><br />PbtO₂ monitoring can reveal cerebral hypoxia that may occur independently of ICP or cerebral perfusion pressure, especially after severe TBI or subarachnoid hemorrhage. Some studies associate oxygen-guided management with improved outcomes, but findings are inconsistent and treatment thresholds and ideal probe placement are not settled. Patient positioning and off-unit transport can affect readings.<br /><br />BIS provides a noninvasive estimate of brain electrical activity and may help assess sedation or neurological status. Evidence for routine ICU sedation management is mixed; possible applications in brain-injury assessment and outcome prediction require further study.<br /><br />Overall, the review emphasizes multimodal assessment, careful nursing observation, infection prevention, and the need for higher-quality research and standardized care practices.

Keywords

intracranial pressure

brain tissue oxygen

bispectral index

neurological monitoring

acute neurological injury

traumatic brain injury

external ventricular drain

cerebral hypoxia

nursing assessment

evidence-based review