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4 - Intracranial pressure

from Section 2 - Monitoring and imaging

Published online by Cambridge University Press:  05 December 2011

Basil F. Matta
Affiliation:
Addenbrooke's Hospital, Cambridge
David K. Menon
Affiliation:
Addenbrooke's Hospital, Cambridge
Martin Smith
Affiliation:
Department of Neuroanaesthesia and Neurocritical Care, the National Hospital for Neurology and Neurosurgery, University College London Hospitals
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Summary

The intracranial pressure (ICP) has three components: an arterial vascular component; a cerebrospinal fluid (CSF) circulatory component; and a venous outflow component. More generally, multiple variables such as the arterial pulsatile pressure, autoregulation and cerebral venous outflow all contribute to the vascular component. Intracranial compliance is a concept often associated with CSF storage. Measurement of brain compliance is classically performed using a CSF bolus injection. In sedated patients with TBI, continuous ICP monitoring is recommended, and can only be achieved by direct invasive measurement. The gold standard for ICP monitoring is a catheter inserted into the lateral ventricle and connected to an external pressure transducer. Cerebral perfusion pressure (CPP)-oriented therapy has been introduced to decrease the risk of ischaemia in post-injury care. Intracranial pressure waveforms include distinct periodic components: heart pulse waves, respiratory waves and quasi-periodic slow vasogenic waves.
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Publisher: Cambridge University Press
Print publication year: 2011

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