Management of Intracranial Hypertension in Traumatic Brain Injury
Management of Intracranial Hypertension in Traumatic Brain Injury Kiran Hebbar, MD 5/31/05
Introduction: Head Injury • Adolescents • Boys>>Girls • Leading cause of trauma death • Primary & Secondary Injury
Key Concepts • Monroe-Kellie Doctrine • CPP=MAP-ICP • Cerebral Blood Flow
Monroe-Kellie • Skull is a fixed, rigid structure • Total Volume – Brain – Blood – CSF
Monroe Kellie Brain+ Blood+ CSF Skull= Brain+ Blood+ CSF
Goals • Maintain Cerebral Perfusion Pressure – >60 mm Hg • Control Cerebral Blood Flow
CPP= MAP-ICP • CPP- Keep >60 • MAP – Hypertensive therapy • ICP • Skull= Brain+ Blood+ CSF
Cerebral Blood Flow • Blood Pressure • Pa. CO 2 • Pa. O 2 • Skull= Brain+ Blood+ CSF
Cerebral Perfusion • Skull= Brain+ Blood+ CSF
Carbon Dioxide Skull= Brain+ Blood+ CSF
Oxygen Skull= Brain+ Blood+ CSF
Quick Review • Importance of Perfusion • Controlling Blood flow • So what can we do?
Management Strategies • Blood – General • Head Position – Midline – 30 degrees • Temperature Skull= Brain+ Blood+ CSF
Hyperventilation • Blood continued • Decrease CO 2 – Vasoconstriction • Decrease blood volume • Skull= Brain+ Blood+ CSF
Sedation • Blood continued • Sedative + Analagesic • Pentobarbital Coma – Burst suppression • Skull= Brain+ Blood+ CSF
Management Strategies • Blood continued – Surgical- Evacuate Bleed/Clot Skull= Brain+ Blood+ CSF
CSF Balance in production and absorption disturbed! Skull= Brain+ Blood+ CSF
Management • Cerebrospinal Fluid – Surgical • External Ventricular Drain (EVD) – Medical • Acetazolimide • Lasix Skull= Brain+ Blood+ CSF
Management Strategies • Brain – Surgical- Resection – Osmotic Agents • Mannitol • 3% Na. Cl Skull= Brain+ Blood+ CSF
Management Strategies • Brain continued • Hemicraniectomy
Management Summary • • 1. Head Position 2. Hyperventilate (intubate) 3. Osmotic Therapy 4. Sedation/Paralysis 5. Temperature 6. Hypertensive Therapy 7. Surgical- EVD/pressure monitor
Thank You! Make time to Decompress!!!!
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