CHASING THE ICP..SORRY CHASING THE WELLNESS OF THE BRAIN❗️

In the want of disease, ICP may rise through 50 mmHg during coughing or sneezing without noticeable neur ologic impairment. 

▶️Therefore, it is the interaction of raised  ICP through other intracranial pathology which produces the pathologic consequences, for example  opposed to the rise in ICP by means of se.  

Monitoring of intracranial hurry (ICP)

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“Some patients with suspected intracranial hypertension and a decreasing point of consciousness might require invasive ICP monitoring, although its added value beyond clinical or radiological monitoring has not still been proven”

Monitoring methods currently advantageous include ventriculostomy, subarachnoid bolt, epidural sensor, and fiberoptic intraparenchymal mentor; the latter is the most commonly used.

▶️DO YOU KNOW?

The major drawback of intraventricular catheters is the reckon of infection which is much higher than that observed using intraparenchymal probes. 

Additionally, meaning of ICP data after craniectomy is uncompliant.

Monitoring of CBF

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▶️Normal medium CBF in the human is not fa from 55 ml/100g (of brain)/min, yet values may vary widely across grey and fortunate matter. The ischemic threshold for CBF is nearly 18 ml/100g/min, with 10 ml/100g/ min often considered the threshold for irreversible injury. 

Laser Doppler flowmetry (LDF) is a parenchymal or superficies Doppler probe that measures tissue local CBF in a quantitative manner. 

Brain accumulation oxygen tension (P bt O 2 ) monitoring allows from father to son measurement of focal tissue oxygen rigor in a specific region of the brain. A P bt O 2  bring to the same ~ below 10-15 mmHg has as the world goes been the threshold identified at which outcome is worsened 

Transcranial Doppler ultrasonography is a available non-invasive monitor of cerebral hemodynamics, limit has been severely disadvantaged by the want of ability to fix the  probe in locality. 

  Jugular venous bulb oximetry is a global hemispheric measure with low sensitivity for detecting regional ischaemia. 

The vertical SjvO 2  level is not fa from 60%

an SjvO 2  of < 50% according to greater than 10 min has as the world goes been considered to represent an ischemic desaturation. 

High SjvO 2 levels may throw back hyperemia (typically >90%) or ~y inability of the brain to pull out oxygen due to metabolic depression from lenient agents, poor oxygen unloading (e.g. sickle cell disease), or severe brain mischief. 

Near-infrared spectroscopy (NIRS) 

measures cerebral regional oxygen fulness by measuring near-infrared light reflected from the chromophobes in the brain, the greatest part important of which are oxyhemoglobin, deoxyhemoglobin, and cytochrome A3. 

Its major limitations include the intersubject variability, the versatile length of the optical path, the possible contamination from extracranial blood, and most important, the lack of a that may be defined threshold. Because of the thin scalp and brain in the neonate and infant, NIRS holds word in this patient population but fragments an investigative tool in its not absent form.

Microdialysis catheters, typically inserted in association with an ICP or tissue Po2 overseer, allows sampling of small molecules in the intermediate fluid. 

An increasing lactate/pyruvate fixed relation is sensitive to the onset of ischemia. 

High levels of glycerol insinuate inadequate energy to maintain cellular rectitude and the resultant membrane breakdown. 

Excitatory amino acids, like as glutamate, are both a marker in favor of neuronal injury and a factor in its increase.

Currently, the microdialysis catheter is in a primary manner used in two situations: (a) extended subarachnoid hemorrhage where subsequent vasospasm is credible and (b) traumatic brain injury (TBI) 

▶️️At donative, none of the methods available is sufficiently reliable or well tested to en adroit us to influence the clinical disposal of neurologically i njured patient by absolute certainty

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Reference:

Advanced cerebral monitoring in neurocritical care Nobl Barazangi, J. Claude Hemphill III, eurology India | October-December 2008 | Vol 56 | Issue 4

Intraoperative Neurophysiological Monitoring Second Edition Aage R. Møller

Postoperative government of adult central neurosurgical patients: Systemic and neuro-monitoring David Pfister, Stephan P. Strebel , Basel, Switzerland Luzius A. SteinerBest Practice & Research Clinical Anaesthesiology Vol. 21, No. 4, pp. 449–463, 2007 

Textbook of Neuroanaesthesia and Critical Care by Basil F Matta

Handbook of Neuroanesthesia, 4th Edition, James E. Cottrell

This universe stops that not those who examined their rate quickly damaged women, continued as suggesting clues or overseeing added.

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