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  • IICP Transes

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    Julia Rae Delos Santos
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    - Normal intracranial pressure is between 8-15 mmHg. Increased intracranial pressure (IICP) is defined as pressure greater than 15 mmHg. - As IICP increases and reaches around 25 mmHg, marked elevation in pressure will be noted. Increased pressure can impede blood flow and cerebral function, potentially leading to herniation and death. - Treatment aims to lower ICP through measures like diuretics, positioning, monitoring, and in severe cases surgery. Prompt treatment is important to prevent neurological impairment or death from increased intracranial pressure.

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    - Normal intracranial pressure is between 8-15 mmHg. Increased intracranial pressure (IICP) is defined as pressure greater than 15 mmHg. - As IICP increases and reaches around 25 mmHg, marked elevation in pressure will be noted. Increased pressure can impede blood flow and cerebral function, potentially leading to herniation and death. - Treatment aims to lower ICP through measures like diuretics, positioning, monitoring, and in severe cases surgery. Prompt treatment is important to prevent neurological impairment or death from increased intracranial pressure.

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    36 views3 pages

    IICP Transes

    Uploaded by

    Julia Rae Delos Santos
    - Normal intracranial pressure is between 8-15 mmHg. Increased intracranial pressure (IICP) is defined as pressure greater than 15 mmHg. - As IICP increases and reaches around 25 mmHg, marked elevation in pressure will be noted. Increased pressure can impede blood flow and cerebral function, potentially leading to herniation and death. - Treatment aims to lower ICP through measures like diuretics, positioning, monitoring, and in severe cases surgery. Prompt treatment is important to prevent neurological impairment or death from increased intracranial pressure.

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    of 3

    • Once ICP reaches around 25mmHg

    INCREASED INTRACRANIAL marked elevation in ICP will be noted.


    PRESSURE (IICP)
    Transcribed by: Julia Rae D. delos Santos

    INTRACRANIAL PRESSURE

    Pressure in the skull that results from the volume


    of 3 essential components:

    1. CSF, 75 mL PATHOPHYSIOLOGY
    2. 2. Blood Volume, 75 mL
    3. CNS tissue, 1400g Brain tissue/
    CSF /
    Blood Volume

    No room for expansion

    Compliance (Monro-Kellie Hypothesis)

    • Normal ICP is between 8-15mmHg. Displacement of CSF Blood flow in the


    • 3 components maintain a state of into Spinal Cavity brain
    equilibrium.
    • The intact cranium cannot be expanded.
    Can only accommodate Can only maintain decreased
    • Monro-Kelie hypothesis: because of a
    CSF to a certain point blood flow for a period of time
    limited space for expansion within the
    skull, an increase in any one of the
    components causes a change in the Limit reached Acidotic Cerebral Metabolism
    volume of the others.
    ➢ Any increase in one of the
    elements must be balanced or IICP
    compensated by a proportional
    constriction either or both of the
    other components. Acidotic env. Causes cerebral swelling

    INCREASED INTRACRANI AL PRESSURE (IICP) Worsening cerebral hypoxia and ischemia


    • A syndrome characterized by increase in
    the amount of CNS tissue, CSF fluid or Death Brain herniation
    blood leading to an ICP greater than
    15mmHg.
    Brainstem compression

    Death
    Increased ICP can Impede the  Doll’s eye phenomena –
    circulation to the brain, stimulates further abnormal when present and may
    swelling, impedes the absorption of CSF, affect occur as the client begins to
    the functioning of nerve cells, and lead to
    experience a decrease in LOC.
    brainstem compression and death.
    Occurs when the client’s head is
    May shift brain tissue, resulting in moved from side to side and the
    herniation, a frequently fatal event.
    eye remain in a fixed midline
    position
    CLINICAL MANIFESTATIONS  Decortication
     Decerebration
    When IICP increases to the when ability to
    adjust has reached its limits, neural function is DIAGNOSTICS
    impaired. (changes in LOC)
    CT scan, MRI, cerebral angiogram, EEG, Caloric
    ▪ Lethargy – earliest sign test (oculovestibular response)
    ▪ Sudden change in condition
    ▪ Patient becomes stuporous and may ICP monitoring device:
    react only to loud auditory or painful
    o Purpose: to identify increased pressure
    stimuli.
    early in its course, to quantify the degree
    ▪ When coma is profound, pupils are
    of elevation, to initiate appropriate
    dilated and fixed, respirations are
    treatment, to provide access to CSF for
    impaired → death.
    sampling and drainage, to evaluate the
    ▪ CUSHING’S TRIADE (late sign)
    effectiveness of treatment.
     HYPERtension + Widened pulse
    o 3 ways to measure ICP:
    pressure
    ➢ Intraventricular catheter – most
     BRADYcardia
    accurate
     BRADYpnea
    ➢ Subarachnoid/Subdural
    screw/bolt
    ASSESSMENTS
    ➢ Epidural Sensor
    ▪ Headache
    ▪ Vomiting MEDICAL MANAGEMENT
    ▪ Diplopia (CN VI)
    Increased ICP is a true emergency and
    ▪ Body temperature may be elevated or must be treated promptly.
    subnormal
    Goals:
    ▪ Pupillary changes
    ▪ Papilledema – swelling of optic nerve o Invasive monitoring of ICP
    ▪ Lateralizing sign – this is a contralateral o Decreasing cerebral edema
    loss of motor function due to decussation o Lowering the volume of CSF
    of motor fibers at the level of medulla
    o Decreasing cerebral blood volume while
    oblongata. maintaining cerebral perfusion
    ▪ Pupillary changes:
    o Pharmacologic therapy
     Ipsilateral pupil dilatation (CN III
    compression) o Patient requires care in the critical care
    unit.
     Bilateral pupil dilatations
    ▪ Brainstem function impairment
    PHARMACOTHERAPY

    ▪ Diuretics (Mannitol, Lasix)


    ▪ Anticonvulsants (Valium, Dilantin,
    Phenobarbital, Tegretol)
    ▪ Antipyretics
    ▪ Muscle relaxants
    ▪ BP medication
    ▪ Corticosteroids – Decadron
    (Dexamethasone)
    ▪ Antacids / H2 receptors
    ▪ Anticoagulants
    ▪ Stool softener
    ▪ Intravenous fluids
    ▪ Electrolyte replacement

    Note: opiates and sedatives are contraindicated


    to the client with IICP. (induce cerebral hypoxia
    and vasodilation)

    TX & COLLABORATIVE MANAGEMENT

    ▪ Adequate oxygenation / Maintain


    respiratory function
    ▪ Position: semi-fowler’s
    ▪ Protect patient from injury
    ▪ Avoid factors that increases ICP (N/V,
    sneezing and coughing, Valsalva
    maneuver, over suctioning, restraints,
    rectal examination, enema, flexion of
    waist, hip or neck)
    ▪ Control fever
    ▪ Monitor intake and output
    ▪ Limit fluid intake to 1200mL/day

    SURGICAL INTERVENTIONS

    ▪ Ventriculoperitoneal shunt – shunts CSF


    from the ventricles into the peritoneum
    ▪ Craniotomy for space occupying lesions
    and cerebral hematoma

    Complications: Herniation, seizures cognitive


    deficits, motor deficits, sensory deficits, coma,
    death.

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