ICP

Question 1

How does ICP affect hemodynamics?

Answer 1

The wrong pressure in the brain reflects perfusion status

Question 2

What is does ICP measure?

Answer 2

Pressure inside the skull

Question 3

Normal range for ICP?

When do we typically begin to tx ICP?

Answer 3

Range is 5 - 15 mmhg

ICP is treated if it is above 20 mmhg

Question 4

Your patients pressure device is on the left side of their head. What side of their body is there pressure issues on?

Answer 4

They will then have pressure problems on the right side

- opposites

Question 5

What is more important: ICP or cerebral perfusion pressures (CPP)?

Answer 5

Cerebral perfusion pressure (CPP) - it is more accurate to the patient’s brain. You can have inflammation in the brain & fluid BUT you can still be perfusing. Now, if you don’t have perfusion - that’s a problem.

Question 6

What are 3 essential components of the skull?

Answer 6

Brain tissue 10%
Blood 12%
Cerebrospinal fluid 78%

Question 7

Defintion of CPP or cerebral perfusion pressure

Answer 7

Pressure needed to perfuse the brain

Question 8

How to calculate CPP

Answer 8

Map - ICP = CPP

Question 9

Normal range for CCP

Low amount? And its associations?

Answer 9

70 to 100 mmhg

Below 50 mmhg is associated with ischemia and neuronal death

Question 10

T/F

You can revive dead brain tissue

Answer 10

False. Once it is gone, it is gone.

Question 11

Where can ICP be measured in?

Answer 11

Ventricles
Subarachnoid space
Epidural space
Brain parenchymal tissue

(wherever the damage is and if there’s a bleed or build up of fluid)

Question 12

Where does the pressure transducer need be reference to when measuring ICP?

Answer 12

Trachus (can use laser)

- foramen Monroe

Question 13

What can increase ICP?

Answer 13

Bleeding
Hydrocephaly
Meningitis
Trauma
Coughing/baring
Not having midline positioning

Question 14

Gold standard for monitoring ICP route?

Answer 14

Ventriculostomy

Question 15

You have a patient having ICP measured. What do you need to check in relation to the drainage bag?

Do you touch the dressing?

Answer 15

Check color and consistency of fluid.

We do not change dressings or manipulate it.

Question 16

What will spinal fluid look like in a meningitis infection patient?

How do we test it for infection?

Answer 16

Cloudy sediment

Test it by doing a lumbar puncture

Question 17

How can ICP be controlled/manipulated?

What needs to be monitored?

Answer 17

We can drain off CSF

But monitor volume and infection risk closely

Question 18

How do you measure ICP? What do you record?

Answer 18

As a mean pressure at the end of expiration

Question 19

What causes inaccurate ICP readings?

Answer 19

CSF can leak
Catheter can be obstructed by sediment 
Kinks
Incorrect height of drainage system relative to reference point
- people move the bed 
Differences in height of bolt/transucer

Question 20

Optimal range for CPP?

Answer 20

60 - 100

Question 21

What do we want to drive for CPP?

Answer 21

Drive MAP (in order to have enough force to perfuse)

• vasopressors; dopamine high dose pressor
• fluids to follow

Question 22

What do we want to minimize for CPP?

Answer 22

Try to minimize the ICP

Question 23

How can we minimize the ICP?

Answer 23

Sedation
Osmotic agents - mannitol, 3% to pull of fluid
Ventriculostomy - pulls fluid to the abdomen

Question 24

Vasopressors used for CPP

Answer 24

Dopamine
Norepinephrine
Neosynephrine
Vasopressin

Question 25

Ask about CPP and renal doses lower than 3 mcg/kg

Answer 25

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