Review of the use of intracranial pressure monitoring in a district general hospital intensive care unit

We report the use of the Codman subarachnoid intra-cranial pressure (ICP) monitor in the management of 10 head-injured patients not requiring neurosurgery (Table 1). The patients' ages ranged from 14 to 37 years. The Glasgow coma score (GCS) on admission ranged from 3 to 7. Computerised axial tomography demonstrated that four patients had Diffuse Injury Type II (associated with a severe outcome or worse in 65.5% patients) and six had a Diffuse Injury III score (associated with a poor outcome in 83.7% patients). Patients were sedated and their lungs ventilated for an average of 8.5 days (range: five to 13 days) as a result of ICP-directed therapy. In spite of the low GCS and poor outcome CT-scans on admission, our series demonstrated a 20% mortality, 20% good recovery, 50% moderate disability and 10% severe disability at six months when followed-up by our rehabilitation unit. There were no complications associated with the ICP monitoring. We conclude that ICP monitoring using the user-friendly Codman subarachnoid bolt is a viable proposition in a district general hospital (DGH) intensive care unit (ICU) to aid the management of head-injured patients not requiring neurosurgery.