Ebook Critical care procedure book: Part 2

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Ebook Critical care procedure book: Part 2

Ebook Critical care procedure book: Part 2ure MonitoringMichelle Ghobrial, MD1, Jacqueline s. Urtecho, MD1 and Jawad F. Kirmani, MD2' 'Neuro-Critical Care. Thomas Jefferson University.Philadel

phia. PA. US:New Jersey Neuro Science Institute. JFK Medical Center, Edison, NJ, USIntroductionWhen brain injuries occur, having a solid understanding Ebook Critical care procedure book: Part 2

of cerebral physiology becomes paramount in managing patients. The intracranial vault is a fixed volume comprised of brain, blood and cerebral spinal

Ebook Critical care procedure book: Part 2

fluid. An increase in the volume of one component will cause a decrease in the volume of the other components, or a compensatory increase in pressure

Ebook Critical care procedure book: Part 2m mean arterial pressure (MAP). CPP is the pressure driving blood through the vessels. In cases of elevated ICP or systemic hypotension, cerebral perf

usion pressure decreases. Normal ICP varies with age and body posture but is generally considered to be 5-15 mmHg in supine adults. The un-injured bra Ebook Critical care procedure book: Part 2

in has intact autoregulation and can make adjustments in vascular tone, reflected as changes in MAP. in order to maintain a normal CPP (50-70 mmHg) an

Ebook Critical care procedure book: Part 2

d cerebral blood flow. After brain injury, autoregulation becomes disrupted and small changes to MAP or ICP can have devastating consequences (Figure

Ebook Critical care procedure book: Part 2s, and papilledema. Vital signs also become unstable, resulting in a phenomenon known as Cushing’s triad: systolic hypertension, bradycardia and respi

rator)’ irregularity. Intracranial monitoring is an* E-mail: jkirmani@gmail.com.82Michelle Ghobrial, Jacqueline s. Urtecho and Jawad F. Kinnaniinvalua Ebook Critical care procedure book: Part 2

ble resource used to guide therapies aimed at lowering ICP and preserving at-risk brain tissue.Figtire 1. Intracranial pressure-volume curve demonstra

Ebook Critical care procedure book: Part 2

ting a compensatory phase followed by a critical threshold after which ICP dramatically rises.MAPFigure 2. Cerebral autoregulation curve showing maint

Ebook Critical care procedure book: Part 2evail.Intracranial Pressure Monitoring83Indications■Acute hydrocephalus with clinical symptoms of intracranial hypertension (intracranial hemorrhage,

mass, or any intracranial pathology causing malignant cerebral edema)•Salvageable patients with severe traumatic brain injury (TBI) with Glasgow Coma Ebook Critical care procedure book: Part 2

Scale (GCS) score <8 and an abnormal computed tomography (CT ) of the head.•Severe TBI with GCS < 8 and normal CT head PLUS at least 2 of following: a

Ebook Critical care procedure book: Part 2

ge >40 years old. abnormal motor posturing, systolic blood pressure <90 mmHgContraindications■Coagulopathy or patients being treated with anticoagulan

Ebook Critical care procedure book: Part 2e the type of monitor to be used:•External ventricular drains (EVDs) are the gold standard for ICP monitoring. A fluid-filled tubing is placed in a la

teral ventricle and connected to an external transducer. This allows drainage of cerebral spinal fluid (CSF) in addition to measurement of intracrania Ebook Critical care procedure book: Part 2

l pressures.■Intraparenchymal monitors only measure pressure without draining CSF.■Epidural, subdural, and subarachnoid pressure monitors are less acc

Ebook Critical care procedure book: Part 2

urate than intraventricular or inlraparenchymal monitors. They do not allow for drainage of CSF.ProcedureICP monitoring devices are typically placed b

Ebook Critical care procedure book: Part 2aced, the neurosurgeon or intensive care physician decides how to remove CSF.