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Intracranial Pressure (ICP)

Intracranial Pressure (ICP). Megan McClintock, MS, RN 11/4/11. Normal Values. ICP 5-15 mm Hg CPP 60-100 mm Hg (< 50 is bad) CSF 20-30 mL /hr. Factors Affecting ICP. Arterial & venous pressure (high or low) Intrabdominal/intrathoracic pressure Posture Temperature

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Intracranial Pressure (ICP)

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  1. Intracranial Pressure (ICP) Megan McClintock, MS, RN 11/4/11

  2. Normal Values • ICP 5-15 mm Hg • CPP 60-100 mm Hg (< 50 is bad) • CSF 20-30 mL/hr

  3. Factors Affecting ICP • Arterial & venous pressure (high or low) • Intrabdominal/intrathoracic pressure • Posture • Temperature • Blood gases (acidosis, hypoxia, high CO2) • All are potent vasodilators

  4. Compensation • Change in CSF volume • Absorption/production • Movement of CSF to the spinal subarachnoid space • Change in intracranial blood volume • Collapse of cerebral veins/dural sinuses • Cerebral vasoconstriction/dilation • Change in venous outflow • Change in brain tissue volume • Distension of dura • Compression of brain tissue

  5. Symptoms of  ICP • Change in LOC • Most sensitive & reliable indicator of neuro status • Change in VS • Cushing’s triad • Change in pupils • Response to light, blurred vision, diplopia, eye movements, papilledema • Change in motor function • Hemiparesis/hemiplegia, decorticate or decerebrate posturing • Headache • Vomiting

  6. Diagnostic Testing • CT • MRI • Angiography • Transcranial Doppler • EEG, Evoked Potentials • PET • NO LP!!!!!!!!

  7. ICP Monitoring

  8. LICOX

  9. Assessment • Glasgow Coma Scale • Pupils • Cranial Nerves • Eye movement • Motor strength • Vital signs (including respiratory pattern - pg 1435)

  10. Treatment • CSF drain, ICP monitoring • ET tube/trach to keep PaO2 at 100, PaCO2 30-35 • Surgical removal of mass • Hemicraniectomy • Only light sedation (ie. Versed, Ativan) • Be careful with drugs that alter the neuro state • Rapid-acting opioids (Morphine, Fentanyl) are best • Propofol is good (rapid-acting, short half-life) • Avoid benzodiazepines

  11. Drugs • Mannitol • Osmotic diuretic given intravenously • Decreases ICP by plasma expansion and osmotic effect • Hypertonic saline (3%) • Can be as effective as mannitol or used concurrently • Raises the osmolality of the ECF in the brain • Corticosteroids • Used for vasogenic edema around tumors and abscesses but not for head-injured patients • Barbiturates • Reduce metabolic rate decreasing CBF and ICP

  12. Interventions • No fever or shivering (or agitation, pain, seizures) • No Valsalva, coughing, sneezing • Avoid restraints • Family member at bedside • Seizure precautions • Quiet, non-stimulating environment • Light touch and talk even if in a coma

  13. Interventions • Respiratory • Patent airway • Watch breathing patterns • Side-lying • Watch for snoring • Careful use of suctioning • HOB  30 degrees • Prevent abdominal distension (NG tube – depends on injury) • Monitor ABGs • Nutrition

  14. Interventions • Fluid & Electrolytes • Monitor closely (esp. Na, Gl, K, Mg, osmo) • Watch for diabetes insipidus & SIADH (pg 1437) • Body position • HOB  30 degrees • No neck flexion • Turn gently and slowly • Avoid extreme hip flexion • Prevent pain

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