1. Management of Intracranial Hypertension in Traumatic Brain Injury Management of Intracranial Hypertension in Traumatic Brain Injury Kiran Hebbar, MD 5/31/05

2. Introduction: Head Injury Adolescents Boys>>Girls Leading cause of trauma death Primary & Secondary Injury

3. Key Concepts Monroe-Kellie Doctrine CPP=MAP-ICP Cerebral Blood Flow

4. Monroe-Kellie Skull is a fixed, rigid structure Total Volume –Brain –Blood –CSF

5. Monroe Kellie Skull= Brain+ Blood+ CSF Brain+ Blood+ CSF

6. Goals Maintain Cerebral Perfusion Pressure –>60 mm Hg Control Cerebral Blood Flow

7. CPP= MAP-ICP CPP- Keep >60 MAP –Hypertensive therapy ICP Skull= Brain+ Blood+ CSF

8. Cerebral Blood Flow Blood Pressure PaCO2 PaO2 Skull= Brain+ Blood+ CSF

9. Cerebral Perfusion Skull= Brain+ Blood+ CSF

10. Carbon Dioxide Skull= Brain+ Blood + CSF

11. Oxygen Skull= Brain+ Blood + CSF

12. Quick Review Importance of Perfusion Controlling Blood flow So what can we do?

13. Management Strategies Blood –General Head Position –Midline –30 degrees Temperature Skull= Brain+ Blood + CSF

14. Hyperventilation Blood continued Decrease CO2 –Vasoconstriction Decrease blood volume Skull= Brain+ Blood + CSF

15. Sedation Blood continued Sedative + Analagesic Pentobarbital Coma –Burst suppression Skull= Brain+ Blood + CSF

16. Management Strategies Blood continued –Surgical- Evacuate Bleed/Clot Skull= Brain+ Blood + CSF

17. CSF Balance in production and absorption disturbed! Skull= Brain+ Blood+ CSF

18. Management Cerebrospinal Fluid –Surgical External Ventricular Drain (EVD) –Medical Acetazolimide Lasix Skull= Brain+ Blood+ CSF

19. Management Strategies Brain –Surgical- Resection –Osmotic Agents Mannitol 3% NaCl Skull= Brain + Blood+ CSF

20. Management Strategies Brain continued Hemicraniectomy

21. Management Summary 1. Head Position 2. Hyperventilate (intubate) 3. Osmotic Therapy 4.Sedation/Paralysis 5. Temperature 6. Hypertensive Therapy 7. Surgical- EVD/pressure monitor

22. Thank You! Make time to Decompress!!!!