Medications are used to minimize the ICP increase when the airway is manipulated-eg, lidocaine 1.5 mg/kg IV 1 to 2 minutes before giving a paralytic.
Nasotracheal intubation can cause coughing and gagging and thereby raise the ICP. read more (using paralysis) is used rather than awake nasotracheal intubation if patients with TBI require airway support or mechanical ventilation Overview of Mechanical Ventilation Mechanical ventilation can be Noninvasive, involving various types of face masks Invasive, involving endotracheal intubation Selection and use of appropriate techniques require an understanding. Rapid-sequence oral intubation Tracheal Intubation Most patients requiring an artificial airway can be managed with tracheal intubation, which can be Orotracheal (tube inserted through the mouth) Nasotracheal (tube inserted through the nose). Nevertheless, close monitoring using the GCS and pupillary response should continue, and CT is repeated, particularly if there is an unexplained ICP rise. Diagnosis is suspected clinically and confirmed by imaging (primarily. Cerebral perfusion pressure (CPP) monitoring has also been recommended as part of management because evidence suggests that it may help decrease 2-week postinjury mortality ( 4 Treatment references Traumatic brain injury (TBI) is physical injury to brain tissue that temporarily or permanently impairs brain function.
read more ) however, some evidence suggests that management using a combination of clinical and radiographic evaluations alone results in equivalent outcomes ( 3 Treatment references Traumatic brain injury (TBI) is physical injury to brain tissue that temporarily or permanently impairs brain function. These systemic changes can significantly increase inpatient mortality during the first few weeks after injury in fragile and susceptible polytrauma patients if unrecognized or undertreated outside an intensive care setting.īasing management of patients with severe TBI on information from ICP monitoring is recommended to reduce in-hospital and 2-week postinjury mortality ( 1, 2 Treatment references Traumatic brain injury (TBI) is physical injury to brain tissue that temporarily or permanently impairs brain function.
read more ), which manifests as acute systolic heart failure. Symptoms include dyspnea, fatigue, and peripheral edema. read more (AKI) and Takotsubo cardiomyopathy (sometimes termed neurogenic stress myocardium or stunned cardiomyopathy Dilated Cardiomyopathy Dilated cardiomyopathy is myocardial dysfunction causing heart failure in which ventricular dilation and systolic dysfunction predominate. These changes can subsequently cause acute kidney injury Acute Kidney Injury (AKI) Acute kidney injury is a rapid decrease in renal function over days to weeks, causing an accumulation of nitrogenous products in the blood (azotemia) with or without reduction in amount of urine. Hypothalamic dysfunction affects the hypothalamic-pituitary-adrenal axis, causing hemodynamic instability, hypertension, and tachycardia from a sympathetic "storm" that upregulates cardiac contractility and induces fluid retention in the kidney. Injury to the hypothalamus, subfornical organ, and nucleus tractus solitarius, which regulate the overall sympathetic tone, blood flow circulation, and baroreflex response, can lead to profound changes in cardiac and renal function. Excessive ICP can also cause short-term and long-term autonomic dysfunction that can result in significant hemodynamic disturbances that are particularly dangerous in patients with polytrauma and other internal organ injuries, fluid depletion, electrolyte imbalance, coagulopathy, hypotension, and anemia from acute blood loss.
read more absent cranial blood flow is objective evidence of brain death. If ICP increases to equal MAP, CPP becomes zero, resulting in complete brain ischemia and brain death Brain Death Brain death is loss of function of the entire cerebrum and brain stem, resulting in coma, no spontaneous respiration, and loss of all brain stem reflexes. read more (and increased morbidity and mortality). If excessive ICP is unrelieved, it can push brain tissue across the tentorium or through the foramen magnum, causing herniation Brain Herniation Brain herniation occurs when increased intracranial pressure causes the abnormal protrusion of brain tissue through openings in rigid intracranial barriers (eg, tentorial notch). Excessive ICP initially causes global cerebral dysfunction Pathophysiology The cerebrum is divided by a longitudinal fissure into 2 hemispheres, each containing 6 discrete lobes: Frontal Parietal Temporal Occipital read more.
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