ICP leveling

Q: 22 years old male is admitted to Neuro-ICU after head trauma. Intra-cranial catheter is inserted to monitor intra-cranial pressure (ICP). Where should ICP monitoring be leveled (zeroed)? (select one)

A) patient’s face

B) right atrium (heart)

Answer: A

In contrast to central venous pressure (CVP), the transducer for ICP is supposed to be leveled at the part of the patient’s face that corresponds to the Foramen of Monro. 

A few external points described are:

1. The outer canthus of the eye.

2. Halfway between the outer canthus of the eye and the tragus of the ear.

3. Patient’s external auditory meatus.

4. If the patient is lateral, between the eyebrow.

#procedures

References:

1. Reinstrup P, Unnerbäck M, Marklund N, Schalen W, Arrocha JC, Bloomfield EL, Sadegh V, Hesselgard K. Best zero level for external ICP transducer. Acta Neurochir (Wien). 2019 Apr;161(4):635-642. doi: 10.1007/s00701-019-03856-x. Epub 2019 Mar 8. PMID: 30848373; PMCID: PMC6431298.

2. Munakomi S, M Das J. Intracranial Pressure Monitoring. 2023 Feb 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31194438.

3. Changa AR, Czeisler BM, Lord AS. Management of Elevated Intracranial Pressure: a Review. Curr Neurol Neurosci Rep. 2019 Nov 26;19(12):99. doi: 10.1007/s11910-019-1010-3. PMID: 31773291.