generalnumber–icpmustbetreatedifitisgreaterthan20mmhg.ppt

* Monitoring for secondary injury is a fundamental aspect of caring for the critically ill patient with a neurologic dysfunction. By utilizing more than one monitoring technique, the observer is more likely to determine whether a genuine change in cerebral physiology has occurred. In the patient with suspected intracranial hypertension, a device may be placed within the cranium to quantify and monitor ICP, and possibly drain excess CSF. Under normal physiologic conditions, mean ICP is maintained below 15 mm Hg. An increase in ICP can decrease blood flow to the brain, causing brain damage. Persistent ICP elevation above 20 mm Hg remains the most significant factor associated with a fatal outcome. A variety of catheters are available to monitor ICP. They can be separated into two categories: 1) those that facilitate drainage and 2) those that do not allow for drainage. Catheters that allow for drainage are attached to a fluid-filled pressure monitoring system and an external transducer. Catheters that do not allow for drainage are of two types: fiberoptic and microsensor. A combination device that includes both intraventricular drainage and fiberoptic catheterization is also available for ICP monitoring. A new hybrid device that combines external ventricular drainage of CSF and monitoring of ICP can be used to monitor ICP and drain CSF both intermittently or continuously. * * Typically ICP is maintained below 15mm Hg. An increase in ICP can decrease blood flow to the brain, leads to brain damage. Positioning: customize to maximize CPP and minimize ICP. HOB elevation can decrease CPP while increasing venous return. Any position that impedes venous return will cause elevation in ICP by impeding drainage from the brain. Avoid trendeleburg, prone, extreme flexion hips, neck High Peep pressures, coughing, suctions, valsalva If need to perform, pace and separate activities. Hyperventilation, slightly reduce Paco 35+/- 2mmHg leads to vasoconstriction cerebral arteries, re