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Neuromonitoring in the intensive care unit. I. Intracranial pressure and cerebral blood flow monitoring

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Abstract

Background

Monitoring the injured brain is an integral part of the management of severely brain injured patients in intensive care. Brain-specific monitoring techniques enable focused assessment of secondary insults to the brain and may help the intensivist in making appropriate interventions guided by the various monitoring techniques, thereby reducing secondary brain damage following acute brain injury.

Discussion

This review explores methods of monitoring the injured brain in an intensive care unit, including measurement of intracranial pressure and analysis of its waveform, and techniques of cerebral blood flow assessment, including transcranial Doppler ultrasonography, laser Doppler and thermal diffusion flowmetry.

Conclusions

Various modalities are available to monitor the intracranial pressure and assess cerebral blood flow in the injured brain in intensive care unit. Knowledge of advantages and limitations of the different techniques can improve outcome of patients with acute brain injury.

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Abbreviations

ABP:

arterial blood pressure

AMP:

amplitude of fundamental component of ICP waveform

CBF:

cerebral blood flow

CBV:

cerebral blood volume

CO2 :

carbon dioxide

CPP:

cerebral perfusion pressure

CSF:

cerebrospinal fluid

CT:

computerised tomography

DID:

delayed ischaemic neurological deficit

EDP:

effective downstream pressure

FV:

flow velocity

HDI:

haemodynamic impairment

ICP:

intracranial pressure

ICU:

intensive care unit

LDF:

laser Doppler flowmetry

MAP:

mean arterial pressure

MCA:

middle cerebral artery

MRI:

magnetic resonance imaging

nCPP:

non-invasively determined cerebral perfusion pressure

nICP:

non-invasive ICP measurement

PET:

positron emission tomography

PI:

pulsatility index

PRx:

pressure reactivity index

RI:

resistance index

RAP:

correlation of amplitude and pressure of ICP waveform

SAH:

subarachnoid haemorrhage

TBI:

traumatic brain injury

TCD:

transcranial Doppler

TD:

thermal diffusion

THRT:

transient hyperaemic response test

US:

ultrasound

ZFP:

zero flow pressure

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Author information

Authors and Affiliations

  1. Department of Anaesthesia, Addenbrooke’s Hospital, Hills Road, CB2 2QQ, Cambridge, UK

    Anuj Bhatia & Arun Kumar Gupta

  2. Neuroscience Critical Care Unit, Addenbrooke’s Hospital, Hills Road, CB2 2QQ, Cambridge, UK

    Arun Kumar Gupta

Authors
  1. Anuj Bhatia
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  2. Arun Kumar Gupta
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Correspondence to Arun Kumar Gupta.

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Part II of this article is available at: http://dx.doi.org/10.1007/s00134-007-0660-9.

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Bhatia, A., Gupta, A.K. Neuromonitoring in the intensive care unit. I. Intracranial pressure and cerebral blood flow monitoring. Intensive Care Med 33, 1263–1271 (2007). https://doi.org/10.1007/s00134-007-0678-z

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  • DOI: https://doi.org/10.1007/s00134-007-0678-z

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