bezvedomievintenzívnejmedicíne.ppt

* INTRACRANIAL PRESSURE Normal curve shape Low compliance * Management Prevention of secondary injury is the aim:optimise CBF: MAP – ICP = CPP MAP 70 mmHg ICP 15 mmHgCPP 60 mmHg and oxygenation:SatO2 90%, SjO2 55% 1. Reduce ICP: Hyperventilation :PaCO2 3,3 – 4 kPa (25-30mmHg) not routinelly only if herniation appears Loop diuretics (furosemid 20-40 mg i.v.), osmotic agents (mannitol 0,5-1 g/kg )- reduce ICP Improved venous drainage: midline haed position + 30°elevation, !! suctioning, PEEP, physiotherapy increase thoracic venous p. Ventriculostomy drainage/decompressive surgery – if other fails No corticosteroids  * 2. Reduce cerebral metabolism: Avoid hyperglycaemia (BS 4-7 mmol/l) hyperglycaemia increase cerebral lactate production Prophylactic anticonvulsants Adequate analgesia and sedation: benzodiazepines, propofol, thiopentone Antipyretics and cooling (33-34 °C maybe neuroprotective) * * Treat complications: Hypotalamic injury :inappropriate ADH secretion – diabetes insipidus Meningitis – ATB Avoid nasogastic tubes in basilar skull fracture * TBI, maxillofaciálne poranenie, haemothoraxTracheostómia – UVP, PEG, drená? hrudníka Thank you! * jcapkova@capko.sk * TRAUMATIC BRAIN INJURY Hypoxia and acidosis Cerebral oedema * Immediate management Stabilize the patient: ABCgive oxygen, support circulation, treat seizures, stabilise the cervical spine as required Consider giving thiamine, glucose (40 ml 40% glucose), naloxon, flumazenil Examine patient Plan for further investigations * ICP peaks at 72 h CPP(cerebral perfusion pressure) = MAP - ICP MAP = APd + 1/3 (APs-APd) CPP is the effective pressure that results in blood flow to the brain.  * CPP(cerebral perfusion pressure) = MAP - ICP CBF (cerebral blood flow) is maintained constant by autoregulation (between a MAP 50- 140 mmHg).Autoregulation is impaired : head injury, acidosis (hypoxia, hypercarbia)  CBF varies passively with CPP (ischemia!!)