ICU Vivas · Raised ICP & TBI
Data viva — interpreting an intracranial-pressure monitoring trend
A data-interpretation viva in which the candidate is given the monitoring numbers from a severe-TBI patient and must calculate the cerebral perfusion pressure, judge it against the BTF targets (ICP 22, CPP 60 to 70), identify that the pressure rise is genuine (not hypercapnia), and outline the management.
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CICMFFICMEDIC
Prompt
A 24-hour intracranial-pressure and cerebral-perfusion-pressure trend, with the mean arterial pressure, the PaCO2, the sodium and the sedation, from a ventilated patient with severe traumatic brain injury.
Stimulus
You are shown the 24-hour trend of a 70 kg ventilated patient with a severe traumatic brain injury, sedated with propofol and fentanyl. The recorded values are:
| Time | ICP (mmHg) | MAP (mmHg) | PaCO2 (mmHg) | Na+ (mmol/L) | Temp (°C) |
|---|---|---|---|---|---|
| 06:00 | 14 | 90 | 38 | 142 | 37.0 |
| 12:00 | 17 | 88 | 37 | 144 | 37.1 |
| 18:00 | 21 | 86 | 37 | 146 | 37.3 |
| 00:00 | 28 | 84 | 38 | 148 | 37.6 |
The pupils remain equal and reactive throughout. The CT on admission showed diffuse cerebral swelling with no surgical mass lesion.[2]
References3ShowHide
- [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.