The intracranial compartmental syndrome: a proposed model for acute brain injury monitoring and management

• Published in: Critical care (London, England) England), 2023-04, Vol.27 (1), p.137-137, Article 137
• Main Authors: Godoy, Daniel Agustín, Brasil, Sérgio, Iaccarino, Corrado, Paiva, Wellingson, Rubiano, Andres M
• Format: Article
• Language: English
• Subjects: Acute brain injury, traumatic brain injury; Airway management; Automation; Brain; Brain Injuries - complications; Care and treatment; Cerebral compliance; Cerebrovascular Circulation; Complications and side effects; Critical care; Edema; Health aspects; Humans; Hypertension; Hypoxia; Injuries; Intracranial compartmental syndrome; Intracranial hypertension; Intracranial Hypertension - diagnosis; Intracranial Pressure; Intracranial pressure waveform; Ischemia; Medical imaging; Monitoring, Physiologic - methods; Morphology; Neuroimaging; Oxygen saturation; Patient monitoring equipment; Patients; Physiology; Traumatic brain injury; Ultrasonic imaging
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-023-04427-4

For decades, one of the main targets in the management of severe acute brain injury (ABI) has been intracranial hypertension (IH) control. However, the determination of IH has suffered variations in its thresholds over time without clear evidence for it. Meanwhile, progress in the understanding of intracranial content (brain, blood and cerebrospinal fluid) dynamics and recent development in monitoring techniques suggest that targeting intracranial compliance (ICC) could be a more reliable approach rather than guiding actions by predetermined intracranial pressure values. It is known that ICC impairment forecasts IH, as intracranial volume may rapidly increase inside the skull, a closed bony box with derisory expansibility. Therefore, an intracranial compartmental syndrome (ICCS) can occur with deleterious brain effects, precipitating a reduction in brain perfusion, thereby inducing brain ischemia. The present perspective review aims to discuss the ICCS concept and suggest an integrative model for the combination of modern invasive and noninvasive techniques for IH and ICC assessment. The theory and logic suggest that the combination of multiple ancillary methods may enhance ICC impairment prediction, pointing proactive actions and improving patient outcomes.