Anaesthesia | Trauma | Management and effects of raised ICP

Mechanisms and Effects of Raised Intra-cranial Pressure and Secondary Insults
Session Overview
Description
This session reviews the physiology relevant to intracranial pressure (ICP) and describes the causes and effects of raised ICP. Techniques of ICP monitoring and the use of ICP- and cerebral-perfusion-pressure-guided therapies are discussed.

Learning Objectives
By the end of this session you will be able to:

• Explain the Monro-Kellie doctrine
• Identify causes of raised intracranial pressure (ICP)
• Describe methods of monitoring ICP
• Describe the management of ICP in the context of stepwise goal-directed protocols
• Recognize coning and describe the appropriate management

Prerequisites
Before commencing this session you should be familiar with:

• Physiology (cerebral blood flow, cerebral perfusion pressure)
• Pharmacology (mannitol, sedation, neuromuscular blocking drugs)

Raised intracranial pressure (ICP) is almost universal after severe traumatic brain injury (TBI). It is multifactorial in origin and leads to disability or death if uncontrolled. Therefore, prompt recognition and treatment are essential.

An understanding of the mechanisms and effects of raised ICP allows early identification of patients at risk and guides rational
therapy (Fig 1).

• First, the physiology of ICP is reviewed, with particular reference to the effects of TBI on cerebral blood flow (CBF) and cerebral ischaemia
• Then, mechanisms of raised ICP are considered with pathophysiological differences highlighted

The clinical effects, monitoring and stepwise management of raised ICP are considered in the second half of the session.