Mechanical Ventilation and Intracranial Pressure.ppt

Mechanical Ventilation and Intracranial Pressure Ouch. Objectives Be able to define ICP and related terminology Identify problems associated with elevated ICP Causes of elevated ICP Monitoring devices Objectives Implications for Respiratory Therapist Intubation techniques Ventilator strategies ICP – What is it? ICP stands for IntraCranial Pressure This is the pressure of the brain, Cerebrospinal fluid (CSF), and the brain’s blood supply within the intracranial space.1 Since The Skull is basically a closed system, an increase in volume will produce an increase in pressure. Elevated ICP = Danger Other Problems Elevated ICP can also affect the perfusion of the brain Cerebral Perfusion Pressure (CPP) is measured by taking the Mean Arterial Pressure (MAP) and subtracting Intracranial Pressure (ICP) What does this mean? This shows that if the ICP goes up… and MAP stays constant… then the CPP decreases. This means the patient is not getting as much blood flow to the brain. Poor Outcomes Having an elevated ICP is one of the most damaging aspects of neurological trauma, and is directly related to poor prognosis.2 Normal Values A normal ICP in an adult ranges from 0-15 mmHG2 An ICP cannot surpass 40 without causing harm.3 Even values between 25-30 are considered fatal if they are prolonged.2 Causes? An elevated ICP can be caused by many different etiologies. Traumatic Brain Injuries Lyme Disease Hydrocephalus Brain Tumor Severe Hypertension Venous Sinus Thrombosis Restricting Jugular Venous flow (i.e. C-collars) Etc. Monitoring There are 4 main types of devices for monitoring ICP4 Intraventricular Catheters Fiber optic Monitors Subarachnoid Bolts Epidural Monitors Intraventricular Catheters4 Most widely used devices – Most Accurate A catheter is actually placed inside one of the ventricles (a fluid filled cavity in the brain where CSF is produced) Allows treatment and monitoring simultaneously Can be used to take out excess CSF, thereby decreasing ICP Fiber optic Monitors4