Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Introduction
- Pharmacokinetics
- Pharmacodynamics
- Drug Interactions
- Therapeutic Drug Monitoring
- Summary
- Introduction
- Pharmacological Principles of Monitoring
- Pharmacological Characteristics of Antibiotics
- Therapeutic Drug Monitoring for Specific Drugs
- Special Circumstances
- Antibiotic Stewardship
- Acknowledgements
- Introduction
- Blood Groups and Cross-Matching
- Safe Transfusion
- Adverse Effects of Transfusion
- Patient Blood Management
- Effective Transfusion in Surgery and Critical Care
- Major Haemorrhage
- Management of Patients Who Do not Accept Transfusion
- Introduction
- Conventional Coagulation Tests
- Point-of-Care Tests
- Fluids
- Inotropes, Vasopressors and Inodilators
- Vasodilators
- Anti-hypertensives
- Introduction
- Aims and Indications for Mechanical Circulatory Support
- Types of Mechanical Circulatory Support
- Implementation and Monitoring of Mechanical Circulatory Support
- Summary and Conclusion
- Initiating Mechanical Ventilation
- Maintenance of Ventilation
- Modes of Ventilation
- Ventilation Considerations
- Special Considerations
- Weaning from Ventilation
- Introduction
- Indications
- Principles and Techniques of RRT
- Nomenclatures for Continuous RRT
- Modalities of RRT
- Timing of RRT Initiation
- Vascular Access
- Dose of RRT
- Fluid Balance and Management
- Anticoagulation
- CRRT Prescription and Monitoring
- Complications of CRRT
- Weaning from RRT
- Conclusion
- Introduction
- How to Provide Nutritional Support
- Refeeding Syndrome
- Protocols
- Summary
- Introduction
- Intracranial Pressure
- Brain Tissue Oxygen Tension
- Jugular Bulb Oximetry
- Cerebral Microdialysis
- Transcranial Doppler Ultrasound
- Continuous Electroencephalography
- 4.1 Principles of Safe Prescription of Drugs and Therapeutics (Including Pharmacokinetics, Pharmacodynamics and Drug Monitoring)
- 4.2 Antibiotic Management and Monitoring
- 4.3 Administration of Blood and Blood Products in Intensive Care
- 4.4 Monitoring Coagulation, Including Thromboelastography
- 4.5 Fluids, Inotropes and Vasopressors, Vasodilators and Anti-hypertensives
- 4.6 Principles of Mechanical Circulatory Support in the Acute Setting
- 4.7 Mechanical Ventilation: Initiation, Maintenance and Weaning
- 4.8 Renal Replacement Therapy in Critical Care
- 4.9 Nutritional Assessment and Support in Intensive Care (Enteral and Parenteral Nutrition)
- 4.10 Neuromonitoring and Cerebral Protection
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
4.10 - Neuromonitoring and Cerebral Protection
from Section 4 - Therapeutic Interventions and Organ Support
Published online by Cambridge University Press: 27 July 2023
Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Introduction
- Pharmacokinetics
- Pharmacodynamics
- Drug Interactions
- Therapeutic Drug Monitoring
- Summary
- Introduction
- Pharmacological Principles of Monitoring
- Pharmacological Characteristics of Antibiotics
- Therapeutic Drug Monitoring for Specific Drugs
- Special Circumstances
- Antibiotic Stewardship
- Acknowledgements
- Introduction
- Blood Groups and Cross-Matching
- Safe Transfusion
- Adverse Effects of Transfusion
- Patient Blood Management
- Effective Transfusion in Surgery and Critical Care
- Major Haemorrhage
- Management of Patients Who Do not Accept Transfusion
- Introduction
- Conventional Coagulation Tests
- Point-of-Care Tests
- Fluids
- Inotropes, Vasopressors and Inodilators
- Vasodilators
- Anti-hypertensives
- Introduction
- Aims and Indications for Mechanical Circulatory Support
- Types of Mechanical Circulatory Support
- Implementation and Monitoring of Mechanical Circulatory Support
- Summary and Conclusion
- Initiating Mechanical Ventilation
- Maintenance of Ventilation
- Modes of Ventilation
- Ventilation Considerations
- Special Considerations
- Weaning from Ventilation
- Introduction
- Indications
- Principles and Techniques of RRT
- Nomenclatures for Continuous RRT
- Modalities of RRT
- Timing of RRT Initiation
- Vascular Access
- Dose of RRT
- Fluid Balance and Management
- Anticoagulation
- CRRT Prescription and Monitoring
- Complications of CRRT
- Weaning from RRT
- Conclusion
- Introduction
- How to Provide Nutritional Support
- Refeeding Syndrome
- Protocols
- Summary
- Introduction
- Intracranial Pressure
- Brain Tissue Oxygen Tension
- Jugular Bulb Oximetry
- Cerebral Microdialysis
- Transcranial Doppler Ultrasound
- Continuous Electroencephalography
- 4.1 Principles of Safe Prescription of Drugs and Therapeutics (Including Pharmacokinetics, Pharmacodynamics and Drug Monitoring)
- 4.2 Antibiotic Management and Monitoring
- 4.3 Administration of Blood and Blood Products in Intensive Care
- 4.4 Monitoring Coagulation, Including Thromboelastography
- 4.5 Fluids, Inotropes and Vasopressors, Vasodilators and Anti-hypertensives
- 4.6 Principles of Mechanical Circulatory Support in the Acute Setting
- 4.7 Mechanical Ventilation: Initiation, Maintenance and Weaning
- 4.8 Renal Replacement Therapy in Critical Care
- 4.9 Nutritional Assessment and Support in Intensive Care (Enteral and Parenteral Nutrition)
- 4.10 Neuromonitoring and Cerebral Protection
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
Summary
Key Learning Points
1. The physiological changes governing the Monro–Kellie doctrine become quickly exhausted when the intracranial volume reaches a critical value, thus expediting intracranial hypertension.
2. The main factors influencing the balance between cerebral oxygen delivery and consumption are cerebral blood flow (CBF), arterial oxygen saturation (SaO2), haemoglobin concentration and cerebral metabolic rate of oxygen (CMRO2).
3. In the critical care unit, the most common advanced neuromonitoring technique involves measurement of intracranial pressure (ICP) and estimation of cerebral perfusion pressure (CPP). However, brain tissue oxygen tension (PtiO2), jugular venous oxygen saturation (SjvO2), cerebral microdialysis, transcranial Doppler ultrasound and continuous electroencephalography are also helpful to detect early complications.
4. Jugular venous oxygen saturation (SjvO2) values <55 per cent may indicate elevated CMRO2, low CBF, systemic oxygen desaturation or cerebral ischaemia. Conversely, readings >75 per cent may represent high CBF, metabolic suppression or massive cerebral infarction.
5. Cerebral microdialysis is an evolving technique that can help to diagnose cerebral ischaemia, traumatic axonal injury and inflammatory insults at early stages. However, more research is needed to validate its clinical use.
- Type
- Chapter
- Information
- Intensive Care MedicineThe Essential Guide, pp. 515 - 518Publisher: Cambridge University PressPrint publication year: 2021
References
References and Further Reading
De Georgia, MA. Brain tissue oxygen monitoring in neurocritical care. J Intensive Care Med 2015;30:473–83.CrossRefGoogle ScholarPubMed
Frontera, JA. Multimodality monitoring in critically ill neurologic patients. In: Reich, DL, Kahn, RA, Mittnacht, AJ, Lebowitz, AB, Stone, ME, Eisenkraft, JB (eds). Monitoring in Anesthesia and Perioperative Care. New York, NY: Cambridge University Press; 2011. pp. 237–48.Google Scholar
Makarenko, S, Griesdale, DE, Gooderham, P, Sekhon, MS. Multimodal neuromonitoring for traumatic brain injury: a shift towards individualized therapy. J Clin Neurosci 2016;26:8–13.CrossRefGoogle ScholarPubMed
Stocchetti, N, Roux, P, Vespa, P, et al. Clinical review: neuromonitoring – an update. Crit Care 2013;17:201.CrossRefGoogle ScholarPubMed
Tisdall, MM. Cerebral microdialysis: research technique or clinical tool. Br J Anaesth 2006;97:18–25.CrossRefGoogle ScholarPubMed