Presentation on theme: "Intracranial Pressure in Traumatic Brain Injury Özlem Korkmaz Dilmen Associate Professor of Anesthesiology and Intensive Care Cerrahpasa School of Medicine."— Presentation transcript:
Intracranial Pressure in Traumatic Brain Injury Özlem Korkmaz Dilmen Associate Professor of Anesthesiology and Intensive Care Cerrahpasa School of Medicine
Learning Objectives First aid for TBI Prevention of secondary brain injury Basic neurophysiology Treatment of increased ICP
Epidemiology of Head Injury 1.5 million people sustain TBI every year in US. Adolescent Males> females Car accidents, motor vehicle crashes, falls
Head Injury 46 years old, male Injured in a car crash Unconscious
Hypoxemia Following Head Injury Immediate or late hypoxemia is common following head injury and is associated with poor neurological outcome. Causes of hypoxemia after TBI: Airway obstruction Abnormal respiratory patterns as a result of cerebral hemispheric or basal ganglia damage Neurogenic alterations in FRC and V/Q matching Acute neurogenic pulmonary edema Aspiration pneumonia/pneumonitis due to impaired airway reflexes and subsequent ARDS Direct lung trauma, pneumothorax or tracheobronchial injury
Disability - D Disability is determined from the patient level of consciousness according to the Glasgow Coma Score.
GLASGOW COMA SCALE I. Motor Response 6 - Obeys commands fully 5 - Localizes to noxious stimuli 4 - Withdraws from noxious stimuli 3 - Abnormal flexion, i.e. decorticate posturing 2 - Extensor response, i.e. decerebrate posturing 1 - No response II. Verbal Response 5 - Alert and Oriented 4 - Confused, yet coherent, speech 3 - Inappropriate words and jumbled phrases consisting of words 2 - Incomprehensible sounds 1 - No sounds III. Eye Opening 4 - Spontaneous eye opening 3 - Eyes open to speech 2 - Eyes open to pain 1 - No eye opening
Exposure and Environment - E The patient’s clothes should be removed or cut in an appropriate manner so that any injuries can be seen.
GCS Severe3-8 Moderate9-12 Mild13-15 Severity of TBI
Prognosis Type of lesion Age Severity of injury as defined by GCS
Primary & Secondary Brain Injury Primary injury: occurs as an imediate result of head trauma (not regarded as treatable) Secondary injury: occurs following primary injury with a delay (minutes, hours, days)
Cerebral Autoregulation Over a wide range of blood pressure, cerebral blood flow remains constant if metabolic demands are unchanged. If blood pressure falls, cerebral vasodilatation occurs to increase flow and thus maintain cerebral oxygen and nutrient delivery. If blood pressure is excessively high the cerebral vessels constrict, maintaining cerebral oxygen and nutrient delivery whilst protecting the brain. Trauma, inflammation, seizure activity and conditions causing raised ICP may abolish auto-regulation and the CPP therefore becomes linearly dependent on MAP.
Impaired Cerebral Autoregulation Trauma, inflammation, seizure activity and conditions causing raised ICP may abolish auto-regulation and the CPP