Intensive Care
Sewing in ventriculostomy
Intubation
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Introduction - Physiology - Technology
Physiology
Intracranial
PressureAutoregulationPerfusionHerniationSeizuresBrain death
Extra-cranial
Airway - Access
Hemodynamics
Acid-base - Electrolytes
Pulmonary edema
Neurogenic - ARDS
Technology
Ventilator
Monitor
Pressure
ICP
Vascular
Saturation
Neurosurgical intensive (also called: "critical") care is a subspecialty of neurosurgery that treats patients with unstable or potentially unstable conditions affecting the central nervous system.
Treatment is based on physiologic considerations, guided by various forms of monitoring, and administered through a variety of devices.
Venous and arterial access are essential for the monitoring and care of most patients admitted to the Neurosurgical ICU.
Venous
A large number of medications used in the management of neurosurgical patients must be administered intravenously (IV) because they are not adequately or quickly enough absorbed through the digestive tract.
Intravenous access is also necessary for delivery of total parenteral nutrition (TPN).
Arterial
Arterial access is useful for periodic sampling of arterial blood (usually for blood oxygenation analysis).
A catheter in the arterial artery provides access also for intra-arterial pressure monitoring.
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Neurosurgical intensive (also called: "critical") care is a subspecialty of neurosurgery that treats patients with unstable or potentially unstable conditions affecting the central nervous system.
Treatment is based on physiologic considerations, guided by various forms of monitoring, and administered through a variety of devices.
Neurosurgical intensive (also called: "critical") care is a subspecialty of neurosurgery that treats patients with unstable or potentially unstable conditions affecting the central nervous system.
Treatment is based on physiologic considerations, guided by various forms of monitoring, and administered through a variety of devices.
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
Factors important in intracranial physiology for intensive care include: autoregulation, pressure-volume relationships, perfusion, herniation, and hyperexcitability (epilepsy).
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
The cerebral arteries dilate and contract to maintain cerebral blood flow constant despite fluctuation in arterial blood pressure.
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
In patients with pathology associated with elevated Intracranial pressure is monitored in the ICU
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
Cerebral perfusion is the blood
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
Herniation is the movement of tissue from one compartment to another. Intracranially this is from one "fossa" to another.
Herniation results when the tissue pressure in one compartment is greater than that in an adjacent compartment and when the compartments are in communication. The tissue moves down a "pressure gradient" from the compartment of higher to that of lower pressure.
Epilepsy (convulsions, seizures) occur frequently in patients with central nervous conditions including hemorrhages, tumors, infections, etc.
When a patient has a seizure there are dramatic increases in the metabolic rate of the cerebral tissue, so great that the normal supply of oxygen carried in the blood is inadequate (many patients with seizures have a condition that is also associated with a less than normal supply of oxygen making the insufficiency even more severe).
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
Cardiac output (CO), cardiac output (CI), systemic vascular resistance (SVR), systolic blood pressure (SBP), diastolic blood pressure (DBP)
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
Electrolytes include metal ions such as sodium, potassium, calcium, and magnesium.
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
Water leaking through the capillaries in the lungs that ends up in the air spaces of the lungs
Pulmonary edema that
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
"Adult respiratory distress syndrome" is results from accumulation of fluid in the airspaces of the lungs.
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
Modern intensive care is heavily technology dependent. Neurosurgical intensive care is as if not not more technologically complex than that of other surgical specialties such as trauma or cardiothoracic.
Ventilators are required fo neurosurgicalr patients tracheally intubated for airway protection, supplementation of breathing force, and/or for hyperventilation.
A variety of physiologic parameters are monitored in the ICU.
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
Intracranial, arterial, and central venous pressure are important indicators of normal and abnormal physiology as well as parameters to which treatments can be titrated (adjusted to effect).
Intracranial pressures
Intracranial pressure is the single most important monitored physiologic parameter. The pressure is
Extracranial physiologic factors such as
hemodynamics,
electrolytes, and
pulmonary function.
Blood pressure depends on volume status, cardiac energy, vascular resistance (drag).
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extracranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.
The concentration of oxygen in the radial artery
Oxygenation is vitally important to neurons.
The concentration of oxygen in the jugular vein just beyond the sigmoid sinus reflects the level of metabolism in the brain. As blood flows through the brain oxygen diffuses out of the blood to supply the neurons and other cells. When metabolism increases the need for, and consumption of, oxygen goes up with a decrease in the amount of oxygen flowing out of the brain through the sigmoid sinus (and into the jugular bulb). Measurement of the jugular venous oxygen saturation gives an indication of the level of cerebral metabolism.
Another factor that affects the oxygen concentration in the jugular venous outflow from the brain is the concentration of the oxygen that enters the brain. Conditions associated with low cerebral oxygen ("hypoxia") are also associated with jugular venous oxygen desaturation.
Carbon dioxide concentration reflects the degree of perfusion: decreased perfusion is associated with acidosis and hypercarbia (elevated concentration of carbon dioxide).
Although intracranial physiology is the crux of much of neurosurgical intensive care, the dependence of the brain on adequate blood flow and oxygen delivery requires attention also to extra-cranial physiologic factors such as hemodynamics, electrolytes, and pulmonary function.