A 52-year-old Caucasian male sustained a TBI due to a motor vehicle accident. He had a Glasgow Coma Scale (GCS) of 13; his mean arterial pressure of 60 mmHg was maintained by a norepinephrine drip. When he developed a dilated left pupil with decerebrate posturing (GCS 5), he required intubation. The computed tomography (CT) showed a large left epidural hematoma (EDH) with a 2 cm midline shift warranting a craniotomy [Figures 1 and 2]. During the surgery, no intracranial pressure (ICP) monitor was placed.
Postoperatively, in the neurocritical invasive care unit, standard ASA monitoring included oxygen saturation (pulse oximeter), end-tidal CO2 monitoring, standard electrocardiographic, arterial line monitoring of blood pressure (BP), and serial arterial blood gas assessments were performed.
The postoperative CT scans showed continued resolution of the EDH and improvement of the edema and midline shift (GCS of 6-7). However, at the end of the 2nd week, the patient expired due to complications of TBI (e.g., multiorgan failure). The main question is whether the use of an ICP monitor would have changed this patient's course and outcome.