Intracranial pressure monitoring and management of traumatic brain-injured patients in resource-constrained health systems

PURPOSE OF REVIEW: In low-resource settings, invasive intracranial pressure (ICP) monitoring is often not available due to its high costs. Therefore, some therapeutic strategies require a different approach than those recommended in the presence of invasive monitoring. In this review, we propose a concise overview on ICP monitoring in low-resource settings, mainly focusing on traumatic brain injury patients. RECENT FINDINGS: In limited-resource settings, where invasive ICP monitoring is not available, the use of protocols, based on clinical examination and neuroimaging, is associated with improved outcomes and should be adopted in daily clinical practice. In recent years, there has been an increase in interest and use of noninvasive methods for estimating ICP. A recent consensus, requiring validation in future clinical studies, was created with the aim to integrate noninvasive ICP (nICP) methods in the above-mentioned protocols. SUMMARY: The creation of protocols that include available/local resources (nICP, neuroimaging, etc.) and the implementation of educational initiatives is a valid strategy for improving care in resource-constrained health systems. Importantly, more research is needed in this area of patient care.