ICU Cases · Raised ICP & TBI
Hot case — the bedside encounter: a TBI patient with an ICP monitor and a pressure spike
A CICM hot case — a 20-minute live bedside encounter on a severe-TBI patient with an ICP monitor. Tests the structured neuro-examination of the sedated patient, the interpretation of the ICP and CPP data and the search for reversible causes of an ICP spike, and the immediate management.
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You are taken to the bedside of a 42-year-old woman who is on day 2 of a severe traumatic brain injury (presenting GCS 6) from a motor-vehicle accident. She is intubated, sedated with propofol and fentanyl, and ventilated. An intraparenchymal intracranial pressure monitor is in situ. Until the last hour her ICP had been well controlled at 14 to 18 mmHg with a CPP of 65 to 70; in the last 30 minutes it has climbed to 30 mmHg, and the nurse asks you to assess her and manage the rise.[1]
[1]References4ShowHide
- [1]Carney N, Totten AM, O'Reilly C, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery, 2017.PMID 27654000
- [2]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [3]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.
- [4]Hutchinson PJ, Kolias AG, Timofeev IS, et al. Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension. New England Journal of Medicine, 2016.PMID 27602507