• ICP monitoring
    • Uses
      • SAH
      • CVA
      • ICH/intracerebral haematoma
      • Meningitis
      • Encephalitis
      • Liver failure
    • ICP monitors can reflect cardiac and respiratory cycles and Fourier analysis gives 3 waveforms
      • A
        • 5-10 min (5-200mmHg) associated with decreased cerebral compliance
      • B
        • 1 minute (<50mmHg) due to changes in respiratory patterns
      • C
        • 7-15s (<20mmHg) due to BP and SVR changes
    • Complications
      • Infection
      • Haemorrhage
      • Incorrect positioning
      • Malfunction
      • Obstruction
    • ICP monitors
      • Intraventricular catheter
        • Can give drugs
        • Send CSF samples
        • Remove CSF
      • Intraparencymal
        • Via fibre-optic cable
      • Subdural pressure transducers
        • Less accurate
      • Jugular bulb oximetry
        • High sats
          • Loss of cerebral autoregulation
          • High ICP can cause shunting of blood past capillary beds
        • Low sats
          • Increased cerebral extraction
            • Hypoxaemia
            • Reduced CBF
            • High ICP
          • Increased oxygen demand
            • Seizures
            • Pyrexia
      • Transcranial doppler
        • Temporal bone window and 2MHz signal
        • Can differentiate between vasospasm and cerebral hyperaemia
        • Useful during CEA to assess collateral supply
        • Monitor patients with TIA/CVA from carotid artery
      • Near infrared spectrometry
        • Non-invasive method of monitoring brain oxygenation
      • Invasive brain tissue oximetry
      • Cerebral microdialysis
        • Allows measurement of energy related metabolites (glucose, lactate, adenosine) and NTs (glutamate, aspartame, GABA)
    • Normal ICP is 7-10 mmHg
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/5/4/130.full.pdf