Utilization of Non-Invasive Intracranial Pressure Monitoring in Traumatic Brain Injury Patients Treated in Low-resource Settings: The Intrigo Study

Background Invasive intracranial pressure (ICP) monitoring is not universally available in low-resource settings, mainly due to high costs. In this scenario, non-invasive ICP (nICP) estimation could be integrated in therapeutic protocols. The objective of this international survey was to describe the utilization of nICP monitoring in this setting. Methods The survey was composed by 23 items. Target respondents were doctors treating severe traumatic brain injury (TBI) patients in low-resource settings without the availability of invasive ICP monitoring. Results One hundred and twenty-six physicians from 114 centers among 21 countries worldwide responded. The main findings of this study were: a) a predominant use of optic nerve sheath diameter (ONSD) as nICP assessment tool; b) the utilization of at least two methods for nICP estimation in approximately half of the cases; and c) the absence of specific protocol for nICP monitoring. We also reported a certain degree of variability regarding the parameters suggestive of intracranial hypertension for each of the methods used. Conclusions Brain ultrasounds, particularly ONSD assessment, are the most frequently utilized tools for nICP estimation in TBI patients managed in low-resource settings worldwide. Educational efforts linked with protocols development could be a step forward to improve the care of TBI in resource-limited settings.