Viarasilpa Tanuwong
Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok, 10700, Thailand.
Curr Neurol Neurosci Rep. 2024 Dec 19;25(1):12. doi: 10.1007/s11910-024-01392-5.
The objective of this review is to provide a comprehensive management protocol for the treatment of intracranial pressure (ICP) crises based on the latest evidence.
The review discusses updated information on various aspects of critical care management in patients experiencing ICP crises, including mechanical ventilation, fluid therapy, hemoglobin targets, and hypertonic saline infusion, the advantages of ICP monitoring, the critical ICP threshold, and bedside neuromonitoring. All aspects of critical care treatment, including hemodynamic and respiratory support and adjustment of ICP reduction therapy, may impact patient outcomes. ICP monitoring allows ICP values, trends, waveforms, and CPP calculation, which are helpful to guide patient care. Advanced neuromonitoring devices are available at the bedside to diagnose impaired intracranial compliance and intracranial hypertension, assess brain function, and optimize cerebral perfusion. Future research should focus on developing appropriate intervention protocols for both invasive and noninvasive neuromonitoring in managing ICP crisis patients.
本综述的目的是基于最新证据提供一套全面的颅内压(ICP)危机治疗管理方案。
该综述讨论了颅内压危机患者重症监护管理各方面的最新信息,包括机械通气、液体治疗、血红蛋白目标值以及高渗盐水输注、颅内压监测的优势、关键颅内压阈值和床旁神经监测。重症监护治疗的所有方面,包括血流动力学和呼吸支持以及颅内压降低治疗的调整,都可能影响患者的预后。颅内压监测可获取颅内压值、趋势、波形以及脑灌注压计算结果,有助于指导患者护理。床旁可使用先进的神经监测设备来诊断颅内顺应性受损和颅内高压、评估脑功能并优化脑灌注。未来的研究应聚焦于制定针对颅内压危机患者进行有创和无创神经监测的适当干预方案。