Management of Intracranial Hypertension in Traumatic Brain Injury

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Management of Intracranial Hypertension in
Traumatic Brain Injury

• Kiran Hebbar, MD
• 5/31/05

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IntroductionHead Injury

• Adolescents
• BoysgtgtGirls
• Leading cause of trauma death
• Primary Secondary Injury

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Key Concepts

• Monroe-Kellie Doctrine
• CPPMAP-ICP
• Cerebral Blood Flow

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Monroe-Kellie

• Skull is a fixed, rigid structure
• Total Volume
• Brain
• Blood
• CSF

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Monroe Kellie
Brain Blood CSF
Skull Brain Blood CSF
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Goals

• Maintain Cerebral Perfusion Pressure
• gt60 mm Hg
• Control Cerebral Blood Flow

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CPP MAP-ICP

• CPP- Keep gt60
• MAP
• Hypertensive therapy
• ICP

• Skull Brain Blood CSF

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Cerebral Blood Flow

• Blood Pressure
• PaCO2
• PaO2

• Skull Brain Blood CSF

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Cerebral Perfusion

• Skull Brain Blood CSF

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Carbon Dioxide
Skull Brain Blood CSF
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Oxygen
Skull Brain Blood CSF
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Quick Review

• Importance of Perfusion
• Controlling Blood flow
• So what can we do?

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Management Strategies

• Blood
• General
• Head Position
• Midline
• 30 degrees
• Temperature

Skull Brain Blood CSF
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Hyperventilation

• Blood continued
• Decrease CO2
• Vasoconstriction
• Decrease blood volume

• Skull Brain Blood CSF

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Sedation

• Blood continued
• Sedative Analagesic
• Pentobarbital Coma
• Burst suppression

• Skull Brain Blood CSF

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Management Strategies

• Blood continued
• Surgical- Evacuate Bleed/Clot

Skull Brain Blood CSF
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CSF

• Balance in production and
• absorption disturbed!

Skull Brain Blood CSF
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Management

• Cerebrospinal Fluid
• Surgical
• External Ventricular Drain (EVD)
• Medical
• Acetazolimide
• Lasix

Skull Brain Blood CSF
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Management Strategies

• Brain
• Surgical- Resection
• Osmotic Agents
• Mannitol
• 3 NaCl

Skull Brain Blood CSF
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Management Strategies

• Brain continued
• Hemicraniectomy

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Management Summary

• 1. Head Position
• 2. Hyperventilate (intubate)
• 3. Osmotic Therapy
• 4.Sedation/Paralysis
• 5. Temperature
• 6. Hypertensive Therapy
• 7. Surgical- EVD/pressure monitor

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Thank You! Make time to Decompress!!!!