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
|
