Laparotomy for refractory ICP

A key management principle in managing severe traumatic brain injury (TBI) is control of elevated intracranial pressure (ICP), thereby allowing adequate cerebral perfusion pressure (CPP) in order to prevent secondary injury to the brain. Although there are many regulatory functions to protect the brain, there are limits to what can be modified. Extensive studies have detailed conventional management of elevated ICP, and there are rare instances when these conventional measures do not work. Recognition of the phenomenon of decreasing ICP after laparotomy has led to the possibility that opening the abdominal compartment may lead to improvement in refractory ICP. The concept of “multiple compartment syndrome” in recent years has helped to outline a strategy for the management of refractory ICP in a last-ditch effort to improve an otherwise dire outcome [1].