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Intensive Care Management of Major Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Severe TBI patients require sedation and mechanical ventilation with PaO2 (>10 kPa) and PCO2 targets (4.5–5.5 kPa). The use of intracranial pressure monitoring is standard when the patient cannot be woken for a clinical neurological assessment. Peak brain swelling occurs about day 5 post-injury, so it is not uncommon for TBI patients to remain sedated and ventilated for prolonged periods. This leaves them susceptible to delirium and agitation after sedation is weaned and can make neurological assessment difficult. It can take a long period of rehabilitation before the neurological recovery can be assessed. These patients are at high risk of VAP, and early feeding is essential as an immune protective measure.51
Neurotrauma: Geriatric neurotrauma
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Extensive evidence to support or refute the benefit of intracranial pressure monitoring in the elderly patient population is lacking. Based on the prevalence of intracranial pressure monitoring reported in studies on patients reported to the National Trauma Data Bank, elderly patients as a group are less likely to receive monitoring compared to those of younger age.
Cleft lip and palate: developmental abnormalities of the face, mouth and jaws
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
In 10-20% of single suture cases and a higher proportion of syndromic multisuture cases the infants develop raised intracranial pressure, which presents with episodes of distress, listlessness and disturbed sleep. This may be associated with papilloedema and untreated, can lead to visual failure. The diagnosis is confirmed with intracranial pressure monitoring.
Safety of treating acute liver injury and failure
Published in Expert Opinion on Drug Safety, 2022
Miren García-Cortés, Aida Ortega-Alonso, Raúl J. Andrade
Development of HE brain edema and intracranial hypertension (ICH) may occur in one-third of cases who progress to grade 3 or 4 HE [145]. More commonly encountered clinical signs are sustained clonus, pupillary abnormalities and increase in muscular tone. Late signs of this complication are arterial hypertension, bradicardia, and mydriasis. Trans-cranial Doppler in combination with arterial Ammonia levels, is a useful noninvasive monitoring tool in less severe cases of neurologic impairment, in order to decide which patients need ICP monitor insertion. However, invasive intracranial pressure monitoring should be considered in more severe cases with high risk of ICH [1]. Mannitol or hypertonic saline should be administered when ICH is detected to increase serum osmolarity, and therefore reduce intracraneal pressure [146,147]. A prospective ramdomized clinical trial showed that mannitol and hypertonic saline have similar reduction in ICP and short‐term survival with significantly reduced rebound cerebral edema with the later. Besides, mannitol has shown an increased risk of kidney injury, thus 3% hypertonic saline seems to be a better modality for management of raised ICP in ALF patients [148].
Brain ultrasound for diagnosis and prognosis in the neurological intensive care unit: a mini review for current development
Published in Neurological Research, 2019
Haomeng Zhu, Xiaokun Geng, Gary B. Rajah, Paul Fu, Huishan Du
Increased intracranial pressure is one of the clinical symptoms caused by many disease etiologies. Intracranial pressure monitoring plays a very important role in critically ill patients and may improve the understanding of the disease and guide clinical treatment. In order to maintain the necessary brain function, adequate cerebral blood flow and appropriate intracranial pressures are critical [32]. At present, minimally invasive ventricle monitoring equipment has been the gold standard for monitoring ICP. Currently, there is a lack of non-invasive techniques to accurately monitor intracranial pressure and replace invasive monitoring. Animal experiments and clinical studies have confirmed that TCD values are a close approximation of the measured intracranial pressure. With a constant blood vessel diameter, the cerebral blood flow velocity is directly proportional to the cerebral blood flow. The change of the TCD spectrum morphology and the change of blood flow parameters can reflect the increase of intracranial pressure.
Incidence of neurobehavioral side effects associated with levetiracetam compared to phenytoin in traumatic brain injury patients
Published in Brain Injury, 2021
Jerika V. Nguyen, Tian Yaw, Holly Gratton
A significantly higher percentage of patients in the levetiracetam group sustained an epidural hematoma (10 [10.5%] vs. 25 [23.8%], p = .016). In addition, patients who received phenytoin were more likely to have a longer inpatient length of stay (8.9 days vs. 7.2 days, p = .015) and ICU length of stay (4.8 days vs. 3.2 days, p = .006). Intracranial pressure monitoring was performed for 31.5% of patients, which was not different between groups (p = .226). Similarly, there were no differences in decompressive craniectomy (18 [18.9%] vs. 15 [14.3%], p = .447), hematoma evacuation (19 [20%] vs. 22 [21%], p > .999), or craniotomy (24 (25.3%] vs. 23 [21.9%], p = .619) rates.