Commentary on Making headway with intracranial hypertension

Journal/Book: AACN Nursing Scan in Critical Care. 1993; 3: 10-1.

Abstract: SYNOPSIS: The author reviews increased intracranial pressure (ICP) and related medical and nursing management. The brain employs compensatory mechanisms to maintain ICP within a normal range of 0 to 15 mm Hg. The author discusses cerebral autoregulation, the ability of the brain to provide for constant blood flow despite fluctuations in mean arterial pressure, as well as the effects of respiration on cerebral blood flow. Intracranial hypertension (sustained ICP above 20 mm Hg) may develop from disruption of the autoregulatory mechanism. Four methods used to measure ICP are intraventricular catheters, subarachnoid or subdural screws or bolts, epidural sensor, and the intraparenchymal catheter. Tracings from ICP monitoring reveal different types of waveforms (A, B, C, and pulse waves) that provide very specific information about ICP and the patient's response to treatments. Other monitored parameters include mixed venous oxygen saturation (SvO2) and jugular oxygen saturation (SjO2), which reflects oxygen saturation of the blood returning from the brain. Normal SjO2 ranges from 60% to 80%. An SjO2 of 50% to 55% would reflect possible cerebral hypoxemia. Cerebral blood flow can be measured invasively using radioactive xenon while transcranial Doppler is currently under investigation as a noninvasive method. The plan of care for elevated ICP focuses on reducing brain, blood, and cerebrospinal fluid volumes; maximizing venous return; treating systemic hypertension; and maintaining oxygenation, normothermia, fluid management, sedation, chemically induced paralysis, and cerebrospinal fluid drainage. Research has concluded that noxious tactile stimuli (suctioning) increase ICP. Current investigations concern the effects on ICP of pleasant sensation such as music and therapeutic touch. [Original article accession number: 1993154931 (CEU, exam questions, tables/charts)]

Note: Document Delivery: DD Locally Held: No Entry Month: 9508

Keyword(s): Coma/ci [Chemically Induced]. Drainage. Education, Continuing (Credit). Fluid Therapy. Hyperventilation, Therapeutic. Inpatients. Intracranial Pressure. Intracranial Pressure, Increased/th [Therapy]. Monitoring, Direct Pressure. Oxygen Saturation/ev [Evaluation]. Patient Positioning. Waveforms

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