Ebook Critical care of the stroke patient: Part 2
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Ebook Critical care of the stroke patient: Part 2
Cambridge Books Onlinehttp://ebooks.cambridge.org/Critical Care of the stroke PatientEdited by Stefan Schwab, Daniel Hanley, A. David MendelowBook DOI Ebook Critical care of the stroke patient: Part 2I: http://dx.doi.org/10.1017/CB09780511659096Online ISBN: 9780511659096Hardback ISBN: 9780521762564Chapter21b - Respiratory care of the ICH patient pp. 286-296Chapter DOI: http://dx.doi.org/10.1017/CB09780511659096.027 Cambridge University Press21bRespiratory care of the ICH patientOmar Ayoub and Je Ebook Critical care of the stroke patient: Part 2anne TeitelbaumIntroductionIndications for intubation and ventilationThe overall incidence of intracerebral hemorrhage (ICH) Is estimated lobe 12-15 cEbook Critical care of the stroke patient: Part 2
ases per 100000 population |1). ICH represents around 15-30% of the overall stroke admissions to die hospital and results In significant disability, mCambridge Books Onlinehttp://ebooks.cambridge.org/Critical Care of the stroke PatientEdited by Stefan Schwab, Daniel Hanley, A. David MendelowBook DOI Ebook Critical care of the stroke patient: Part 2ions, and this accounted for 68% of the overall mortality. Indeed, the frequency of use of ‘do not resuscitate’ orders Is highly associated with the odds of dying In hospital from ICH [3). When aggressive management Is instituted, patients who are treated In the neurologic Intensive care unit have a Ebook Critical care of the stroke patient: Part 2 lower mortality rate than those hospitalized in a general ICU pl]. The effect on morbidity, however, is related to the cause of respirator)' failure.Ebook Critical care of the stroke patient: Part 2
When the problem is that of incomplete airway protection due to structural weakness or dysfunction, the intubation and ventilation will improve both Cambridge Books Onlinehttp://ebooks.cambridge.org/Critical Care of the stroke PatientEdited by Stefan Schwab, Daniel Hanley, A. David MendelowBook DOI Ebook Critical care of the stroke patient: Part 2verall outcome (5|.nils chapter will address airway assessment and management in the critically ill patient with ICH, focusing on methods of assessment, indications for intubation, ventilation and tracheostomy, methods of ventilation, and the indications and implementation of successful weaning from Ebook Critical care of the stroke patient: Part 2 the ventilator.Among patients admitted to ICUs, 20% will have an acute neurological disorder as the principal Indication for Instituting mechanical vEbook Critical care of the stroke patient: Part 2
entilation (MV), with half of these patients receiving MV for neuromuscular disease and the other half for coma or central nervous system dysfunction Cambridge Books Onlinehttp://ebooks.cambridge.org/Critical Care of the stroke PatientEdited by Stefan Schwab, Daniel Hanley, A. David MendelowBook DOI Ebook Critical care of the stroke patient: Part 2gic and systemic injury resulting from hypoxia or hypeicapnea.The decision to intubate and mechanically ventilate the patient depends on the clinical picture, even before imaging. The general Indications for Intubation In this particular subset of patients includes decreased level of consciousness w Ebook Critical care of the stroke patient: Part 2ith a GCS of 8 or less, raised ICP, inability to protect the airway, anticipation of decline, co-existing pulmonary indications and as a temporizing mEbook Critical care of the stroke patient: Part 2
easure prior to surgical intervention.In the next sections, we will go over the different indications and physiological rationale for intubation and MCambridge Books Onlinehttp://ebooks.cambridge.org/Critical Care of the stroke PatientEdited by Stefan Schwab, Daniel Hanley, A. David MendelowBook DOI Ebook Critical care of the stroke patient: Part 2.(X2) and damage to the brainstem with or without abnormalCritical Care of the Stroke Patient, cd. Stefan Schwab. Daniel I lank-y, and A. David Mcndeiow. Publisbed by Cambridge University Press. Cambridge University Press 2014.286Or*r»í»Oíơ P:Ebook Critical care of the stroke patient: Part 2
he cause of encephalopathy, there Is an association between reduced level of consciousness and depression of the respiratory drive, hypoventilation anCambridge Books Onlinehttp://ebooks.cambridge.org/Critical Care of the stroke PatientEdited by Stefan Schwab, Daniel Hanley, A. David MendelowBook DOI Ebook Critical care of the stroke patient: Part 2ould occur with normal or only slightly increased 1CP as well. The causes of coma without ICHT include brainstem hemorrhage, cerebellar hemorrhage, relatively small mesial temporal hemorrhage with uncal herniation but without massive change in global ICP, and concomitant toxic or metabolic encephalo Ebook Critical care of the stroke patient: Part 2pathy.For the obtunded or comatose patient with decreased respiratory drive, intubation is not only to maintain airway but also to provide ventilationEbook Critical care of the stroke patient: Part 2
. If there is increased ICP, ventilation assures not only nonno-capnea but is used as a method to lower ICP through hyperventilation.High ICPMechanicaCambridge Books Onlinehttp://ebooks.cambridge.org/Critical Care of the stroke PatientEdited by Stefan Schwab, Daniel Hanley, A. David MendelowBook DOI Ebook Critical care of the stroke patient: Part 2ntracranial hypertension. Almost invariably, these patients require MV because of the accompanying decrease in their level of consciousness. The high ICP seen In hemorrhagic stroke is due to the mass effect of the hematoma as well as the surrounding edema. MV in this scenario Is used not only to pro Ebook Critical care of the stroke patient: Part 2tect the airway and assure oxygenation but also to stabilize and reduce ICP.HyperventilationIf there is clinical or objective evidence of herniation,Ebook Critical care of the stroke patient: Part 2
therapeutic hyperventilation is indicated and proven effective In ICH while completing the investigation and beginning other methods of ICP reduction.Cambridge Books Onlinehttp://ebooks.cambridge.org/Critical Care of the stroke PatientEdited by Stefan Schwab, Daniel Hanley, A. David MendelowBook DOI Ebook Critical care of the stroke patient: Part 2ecrease leading to a decrease in ICP. The range in which PaCXJj has the greatest impact on cerebral vessel caliber is 20-60 mmHg. Within this range. CBF changes 3% for every 1 mmHg change in PaCO2 [8]. Ebook Critical care of the stroke patient: Part 2Cambridge Books Onlinehttp://ebooks.cambridge.org/Critical Care of the stroke PatientEdited by Stefan Schwab, Daniel Hanley, A. David MendelowBook DOIGọi ngay
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