Introduction: Traumatic brain injury is a leading cause of pediatric morbidity and mortality worldwide and ICP monitoring plays a crucial role in its management.Based on existing literature,the authors review the current practicing non-invasive ICP monitoring devices and their accuracy in predicting raised ICP in pediatric TBI.

Methods: A thorough literature search was conducted on PubMed,Medline and Cochrane data base,27 articles were selected systematically,relevant data was summarized.

Results: The ICP targeted therapy results in better outcome of the patient.TCD can provide significant inputs on early vasospasm detection,cerebrovascular autoregulation and circulatory arrest in addition to ICP monitoring.The basic principle in using ONSD to detect raised ICP is its anatomical continuity with duramater and subarachnoid space of the brain.So if there is an increase in the CSF pressure,the sheath may expand and consequently its diameter increases.Distortion product otoacoustic emission (DPOAE) is a type of OAE that is often used for the assessment of middle ear function, and has been tested for noninvasive ICP monitoring.Deep tissue penetration and low absorptivity form the basis of using near infrared spectrum as a noninvasive technique to monitor ICP fluctuations.Heppner et al. proposed noninvasive contrast enhanced ultra-sonographic assessment and its use in assessing cerebral perfusion and ICP in patients with severe TBI.In quantitative pupillometry,asymmetry of pupillary size greater than 0.5mm was observed infrequently in healthy volunteers and was rarely seen in head-injured patients unless the ICP exceeded 20 mmHg.

Conclusions: The assessment of ICP is essential in the management of acutely raised ICP where efforts to keep it down or actively reduced are needed.Invasive monitoring methods are the current 'gold standard' for monitoring ICP.Of all the non-invasive methods based on current literature,we found TCD and ONSD the best tools to monitor ICP in pediatric TBI.The promising results and developments of non-invasive ICP monitoring modalities with its ideal features of high sensitivity,diagnostic accuracy and simple acquisition technique may make it the future of neurointensive monitoring in pediatric TBI.

Patient Care: The article provides the current update on the non-invasive ICP monitoring methods in pediatric TBI and these methods help to overcome the complications associated with invasive monitoring methods.

Learning Objectives: 1. Advancements of non-invasive ICP monitoring methods. 2. Efficacy and safety profile of non-invasive modalities of ICP monitoring in pediatric TBI. 3. Future direction of head trauma critical care in pediatric population.

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