Professional Documents
Culture Documents
Intracranial Pressure
ALL NUMBERS GIVEN ARE ISH
4/19/2011
ENMU-Roswell
4/19/2011
ENMU-Roswell
Neurological Pathophysiology
Cerebral blood flow (CBF) interrupted by:
Structural changes or damage Circulatory changes Alterations in intracranial pressure (ICP)
Monroe-Kellie Doctrine
The cranial vault is a fixed space consisting of 3 compartments:
Parenchyma (neurons and neuroglial tissue) - 80% CSF - 10% Blood - 10%
Therefore, expansion of one compartment results in a compensatory decrease in another in order to maintain ICP
4/19/2011
ENMU-Roswell
4/19/2011
ENMU-Roswell
Intracranial Space
Brain tissue Mostly water, intracellular and extracellular Blood - Intracranial circulation of blood is about 1000 liters per day delivered at a pressure of 100 mmHg and at any given time time, the cranium contains 75 ml (ish) Major arteries in base of brain Arterial branches, arterioles, capillaries, venules, veins within brain substance Cortical veins and dural sinuses
Intracranial Space
Water in:
Ventricles of brain Cerebrospinal fluid
Is constantly secreted, and after circulating, absorbed at an equal rate CSF circulation is slow (500 to 700 ml/day) At a given time the cranium contains 75 ml of CSF
4/19/2011
ENMU-Roswell
4/19/2011
Important Concepts
Cerebral blood flow depends on cerebral perfusion pressure Cerebral blood flow controls oxygen and glucose delivery and waste removal It depends on the pressure gradient across brain
Cerebral perfusion pressure (CPP) and cerebral vascular bed resistance CPP determined by:
Mean arterial pressure (MAP): (Diastolic pressure + pulse pressure) minus intracranial pressure
4/19/2011
ENMU-Roswell
4/19/2011
ENMU-Roswell
Example:
Patient has an ICP of 80 and a MAP of 113 113 MAP - 80 ICP = 33 CPP (BAD)
Best if > 70 mm Hg < 60 mm Hg = impaired blood flow to brain Can lead to seizure, coma and death
4/19/2011 ENMU-Roswell
4/19/2011
ENMU-Roswell
12
4/19/2011
4/19/2011
ENMU-Roswell
13
4/19/2011
ENMU-Roswell
14
4/19/2011
ENMU-Roswell
15
Treatment
Ventilation: What is optimal PaO2 level?
Keep PaO2 between 90-120mmHg or SPO2
4/19/2011
Treatment
Analgesia and Sedation
Reduces movement Helps with ventilation Reduces perceived pain Limits responses to procedures such as suctioning
Of Course
4/19/2011
ENMU-Roswell
22
Devices
Interventricular cannula (IVC) Epidural catheter Subdural / subarachnoid monitoring devices Fiber optic transducer tipped probe
4/19/2011
IVC
Disadvantages
Infection Injury to brain Clot formation Hemorrhage risk Collapsed ventricle Placement may be impossible
4/19/2011
Questions?
4/19/2011
ENMU-Roswell
31