Sunday, May 31, 2015

TBI 2. ICP Monitoring




Key points:
ICP monitoring doesn’t replace exam and radiography.
External ventricular drains (EVD’s) are preferred but parenchymal monitors are acceptable if coagulopathy is present or technical factors (eg, tight ventricles) prohibit access.
Some monitoring is better than no monitoring.
Acceptable upper limit of ICP is now 20-25.
Target CPP>70mmHg

Indications for ICP monitoring:
1.     GCS < 8 AND Positive CT (structural damage)
2.     GCS > 8 AND Positive CT with high risk for progression
No ICP monitor if GCS < 8 WITHOUT structural damage on CT or evidence of elevated ICP either by exam or imaging.
If no improvement in exam, then repeat CT head.

Causes of Elevated ICP
                  Edema (cellular/extracellular)
                  Venous Outflow Obstruction
                  Hyperemia (Autoregulation / Vasodilation)
                  Mass Effect (Hematoma)
                  CSF Circulation

Medical Goals for TBI

ABG
Vitals
Chemistry
Coags
Head
PaO2 > 100 or Sat > 95%
SBP > 100
Glc 80-180
INR < 1.4
ICP 20-25
PaCO2 35-45
Temp 36-38
Na 145-150
Plts > 75
PbtO2 > 20
pH 7.35-7.45


Hb > 7
CPP > 70