Chapter 57- ICP

7/23/2019 Chapter 57- ICP

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Increased Intracranial Pressure

Monro-Kellie hypothesis:becauseof limited space in the skull, anincrease in any one skull componentbrain tissue, blood, or CSFnecessitates a change in the volume ofanother

Compensation to maintain a normalICP of 10 to 0 mm !g is normally

accomplished by shifting or displacingCSF"ith disease or in#ury, ICP may

increaseIncreased ICP decreases cerebral

perfusion, causes ischemia, cell death,


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ICP and CPP

&ormal ICP is 10 to 0 mm!g

CCP $cerebral perfusion pressure% is

closely linked to ICP

CCP ' ()P $mean arterial pressure% * ICP

&ormal CCP is +0 to 100

) CCP of less than 0 results in

permanent neuralgic damage


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-arly Signs of ICP.he earliest sign of increasingICP is a change in /C

Slo2ing of speech and delayin response to verbal

suggestions are other earlyindicators


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3etecting -arly Indications ofIncreasing ICP

3isorientation, restlessness, increasingagitation, increased respiratory e4ort $5ussmaulbreathing%, purposeless movements, andmental confusion

Pupillary changes and impaired e6traocularmovements

"eakness in one e6tremity or on one side of the

body!eadache that is constant, increasing inintensity, and aggravated by movement orstraining


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ther manifestations

include7

8ehavior changes

Sei9ures

&ausea and :omiting/ethargy


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in ICP is a medical

emergency.reatment should

be initiatedimmediately


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"ays to relieve an increase in ICP

3ecrease Cerebral-dema

(annitol

Fluid ;estrictions )ssess 8P, skinturgor, mucousmembranes, urineoutput < osmolality

I: Fluids prescribed* slo2 to moderaterate

ral hygiene b=c ofdehydration

(aintainingCerebral Perfusion

3obutre6

/evophed5eep head in amidline position

)void e6treme hip

>e6ion)void the :alsalvamaneuver


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;educing CSF andIntracranial 8lood

:olume3rain CSF

)septic techni?ueand assess for

signs of infection!yperventilation *as a last resort

Controlling Fever)ntipyretic medications

!ypothermia blanket

)void shivering in the

patient;emoving all bedding overthe patient $e6cept for alight sheet%

@iving cool sponge bathsand an electric fan to

facilitate cooling

(onitor temperaturefre?uently * monitorresponse to therapy and toprevent e6cess decrease in

temperature and shivering


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(aintaining6ygenation

(aintain a patentair2ay

3iscourage coughingand straining

)uscultate lungs everyA hours

(onitor )8@s andPulse o6ymetry

ptimi9e hemoglobinsaturation

;educing (etabolic

3emands!igh doses ofbarbiturates

Paralytics


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3ue to the use of paraly9ing agentspatient 2ill re?uire7

Continuous cardiacmonitoring

-ndotracheal intubation

(echanical ventilation

ICP monitoring

)rterial pressure monitoring


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(onitoring ICP

:entriculostomy7

)5) :entricular Catheter (onitoring 3evice

Fine bore catheter is inserted into the nonB

dominant hemisphere of the brainCatheter connected to a transducer that monitorsthe ICP and ;ecords dataBscillator scope

)llo2s for ICP relief by allo2ing for CSF release

thus relieving intercranial !.&Intraventricular (ed )dministration access

)ir or contrast administration for :entriculography


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Ventriculostomy with fber optictransducer-tipped device

Complication of

Ventriculostomy:

Infection

Meningitis

Ventricular

Collapse

Occlusion of

catheter device by

brain or blood

materials

Problems with

monitoring system


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(onitoring ICP $continued%

Subarachnoid Scre2 or 8olt7

Scre2 or bolt is a hollo2 scre2 that isinserted through a hole drilled in the skull

and through a hole cut in the dura materin to the subarachnoid space

!ollo2 scre2 avoids complications from brainshifting

3oesnt re?uire ventricular puncture

Infection < clogging scre2 2ith brain mattera4ecting readings


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Subarachnoid screw or bolt


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-pidural Sensor7

-pidural 3evice is placed through aburr hole drilled in the skull, #ust overthe epidural covering Esespneumatic pressure to signal analarm for pressure abnormalities

-pidural lining is not perforated, thusless invasive < less infection

Cannot relieve e6cess CSF


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Fiber ptic Sensor

Fiber ptic device can be insertedinto the ventricle, subarachnoid andsubdural space (iniB.ransducerconverts ICP readings into electronicdigital monitoring

"hen inserted in to the ventricle canallo2 for CSF 2ithdra2al


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.rending ICP :alues

ICP "aves7

) "avesBCan last B0minutes 2ith amplitudesbet2een 0B100 mm!g

8 "avesB0 seconds to minutes 2ithamplitudes up to 0mm!g

C "aves * ccur up Gtimes a minute 2ithamplitudes up to mm!g


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&e2 .rends in &euro (onitoring

/ico6 Catheter

) in 1 2hite mattercatheter that measures ICP,.emperature, and endcapillary tissue o6ygen level

@ives real time feed back ofICP management, guidingtherapy and o6ygenation oftissue at risk in thecerebrum

.he temperature probe canbe replaced 2ith amicrodialysis probe

Picture from I&.;-@) 2ebsite7 http7==222integraBiscom=P3Fs=lico6=&S+H0ICPH0CatheterH02H0I(C

H08oltpdf


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/ate (anifestations of Increased ICP

Further deterioration of /C stuporto coma

3ecreasing level of responsiveness accidity may occur


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Decorticate Posturing

Decerebrate Posturing


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/ate (anifestations of Increased ICP cont

)lterations in vital signs

Increase in systolic blood pressure

"idening of pulse pressure

Slo2ing of the heart rate pulse may >uctuate

rapidly from tachycardia to bradycardiaIncrease in temperature

Cushings !riad7 bradycardia, hypertension,< bradypnea

Immediate intervention re?uired to preventherniation of brain stem < occlusion of blood >o2

Cessation of cerebral blood >o2 results in cerebralischemia, infarction, < brain death


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/ate (anifestations of Increased ICPcont

:isual changes pupillary changes re>ectingpressure on optic=oculomotor nerves

Pupils decrease or increase in si9e or become une?ual

/ack of con#ugate eye movement

Papilledema

Pro#ectile vomiting may occur 2ith increasedpressure on the re>e6 center in the medulla

/oss of brain stem re>e6es, including pupillary,corneal, gag, < s2allo2ing re>e6es

/oss of re>e6es is an ominous sign of approachingbrain death


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Classic J6edand dilated

Kblo2n pupilL)bsence ofoculocephalicre>e6 or KdollseyeL

Picture7 http7==imagesgooglecom=imgresMimgurl'http7==222o2lnetriceedu=Npsyc1=Images=3ilatedPupil#pg


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(a#or complication ofIncreased ICP B!ernation

$1% !erniation of the

cingulate gyrus under thefal6 cerebri $% Centraltranstentorial herniation$% Encal herniation of

the temporal lobe intothe tentorial notch $R%Infratentorial herniationof the cerebral tonsils


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3iabetes insipidus is theresult of decreasedsecretion of antidiuretichormone $)3!%

SI)3! is the result of

increased secretion of)3!)ll information other than the /ico6 slide, and blo2n pupil slide is from 8runner < Suddarths .e6tbook of (edicalBSurgical

&ursing, 11th edition http7==thepointeeditionl22com=pt=re=T+A0+A1+T+AG=bookcontent01GTGB11thO-ditionBRhtm#sessionid'[email protected]/VgV+m6@yvpykn;hhvP;:UG5pkpWsU..TA;tPFhy/XBTAG1TRX1A11TGTXA0T1XB1 Information compiled by Stephen Strom, (ichelle !arris, )ngela;eaves, Su9anne Finch, and )manda 5ing


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Chapter 57- ICP