Non-Invasive Intracranial Pressure Estimation in the Intensive Care Unit: Narrative Review of Methods and Clinical Applications

Authors

• Edoardo Picetti
• Daniele Guerino Biasucci
• Elisa Gouvea Bogossian
• Sérgio Brasil
• Danilo Cardim
• Marek Czosnyka
• Daniel A Godoy
• Gregory W J Hawryluk
• Mohammad I Hirzallah
• Frank A Rasulo
• Carla Bittencourt Rynkowski
• Andres M Rubiano
• Fabio Silvio Taccone
• Chiara Robba

Language

English

Publication Date

4-1-2026

Journal

Intensive Care Medicine

DOI

10.1007/s00134-026-08420-7

PMID

42043555

PMCID

PMC13221341

PubMedCentral® Posted Date

4-27-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Despite invasive methods are the gold standard for intracranial pressure (ICP) measurement, several non-invasive techniques (nICP) have been proposed as surrogate, although their use remains insufficiently recognized in clinical practice. These include transcranial Doppler blood flow velocity  assessment (arterial or venous), optic nerve sheath diameter (ONSD), automated pupillometry, measurement of skull expansion and compliance, brain imaging, double-depth ophthalmic artery blood flow velocity, and ultrasound time-of-flight. The main limitations of all indirect methods are calibration and zeroing, which constrain the absolute accuracy of non-invasive ICP monitoring. For transcranial Doppler-based methods, the 95% limits of agreement are approximately ± 7-15 mmHg, while for ONSD-based techniques they range from ± 7-10 mmHg. Improved predictive accuracy may be achieved by combining different modalities and applying advanced signal analysis techniques. Importantly, in patients with acute brain injury, nICP can complement invasive monitoring by guiding patient selection for urgent monitoring, facilitating brain assessment in moderate traumatic brain injury, and assisting management in patients with coagulopathy. In the general intensive care population, nICP may provide valuable information after cardiac arrest, liver failure, and sepsis. In the emergency department, early detection of intracranial hypertension helps prevent missing the "golden hour" of brain care. Finally, nICP is particularly relevant in low-resource settings, where intensive care facilities are limited.

Keywords

Humans, Intracranial Pressure, Intensive Care Units, Ultrasonography, Doppler, Transcranial, Monitoring, Physiologic, Optic Nerve, Intracranial Hypertension, Critical Care, Blood Flow Velocity, Non-invasive intracranial pressure, Outcome, Intensive care medicine, Secondary brain damage, Brain ultrasound, Automated pupillometry

Published Open-Access

yes

Recommended Citation

Picetti, Edoardo; Biasucci, Daniele Guerino; Gouvea Bogossian, Elisa; et al., "Non-Invasive Intracranial Pressure Estimation in the Intensive Care Unit: Narrative Review of Methods and Clinical Applications" (2026). Faculty, Staff and Students Publications. 7232.
https://digitalcommons.library.tmc.edu/baylor_docs/7232