Just a quick word about Intracranial Hypertension (ICH): Intracranial Pressure (ICP) Normal value 0 - 15 mmHg. Cerebral Perfusion Pressure = MAP-ICP. Normal CPP = 70 - 90 mmHg. CPP < 60 mmHg may result in cerebral ischemia. Obviously, we cannot measure ICP in the field, thus I used to utilize 15 to 20 for ICP when treating significant TBI, and titrate MAP to maintain the pt's CPP > 60 mmHg.
Factors that increase ICP: hypercarbia, hypoxia, hypervolemia, flexion of the head, neck, or hip. Noxious stimuli. We used to raise the head of bed (HOB) by 30 degrees to decrease ICP, however, doing so decreases the mean arterial pressure (MAP), thus negating it's effect. It's critical to remember in TBI patients, everything we do has an effect, either positive or negative to the patient.
Just a quick word about Intracranial Hypertension (ICH): Intracranial Pressure (ICP) Normal value 0 - 15 mmHg. Cerebral Perfusion Pressure = MAP-ICP. Normal CPP = 70 - 90 mmHg.
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Factors that increase ICP: hypercarbia, hypoxia, hypervolemia, flexion of the head, neck, or hip. Noxious stimuli. We used to raise the head of bed (HOB) by 30 degrees to decrease ICP, however, doing so decreases the mean arterial pressure (MAP), thus negating it's effect. It's critical to remember in TBI patients, everything we do has an effect, either positive or negative to the patient.
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