The management of head injury and intracranial pressure |
| |
| Affiliation: | 1. Department of Anaesthesia, Addenbrooke''s Hospital, Cambridge, UK;2. Neuro-critical care, Addenbrooke''s Hospital, University of Cambridge, Cambridge, UK;1. Yale School of Medicine, 100 York Street, Suite 1F, New Haven, CT 06511, USA;2. Investigative Medicine Program, Yale School of Medicine, 100 York Street, Suite 1F, New Haven, CT 06511, USA;1. Department of Psychiatry, Virginia Commonwealth University, 515 North 10th Street, Richmond, VA 23298, USA;2. Department of Pediatrics, Virginia Commonwealth University, 515 N 10th Street, Richmond, VA 23298, USA;3. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Hall Mercer Building, 245 South 8th Street, Philadelphia, PA 19107, USA;1. School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa;2. School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa;3. Gender Health and Justice Research Unit, University of Cape Town, Cape Town, South Africa;4. Burden of Disease Research Unit, Medical Research Council, Cape Town, South Africa;1. Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA;2. Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 West 168th Street, Room 1508, New York, NY 10032, USA;1. Department of Neurology, Mayo Clinic, Rochester, Minnesota;2. Department of Biostatistics, Mayo Clinic, Rochester, Minnesota;3. Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota |
| |
| Abstract: | ![]()
Severe head injury occurs predominantly in the young population. Although the incidence is decreasing in the United Kingdom, the eventual outcome of these patients has major social and economic implications. Damage to brain tissue during head injury is both primary, due to the initial insult, or secondary, which occurs later. Because little can be done about the primary injury, the intensive care management is targeted at reducing the secondary insults which may cause further brain damage. The prevention of secondary injury involves prompt airway management and treatment of hypoxia and hypotension. Severe head injury often causes raised intracranial pressure (ICP). The management is focused on maintaining cerebral perfusion pressure, which should be maintained above 70 mmHg by adequate fluid replacement or by the judicious use of inotropes. The methods to control ICP include general measures (15° head up position, avoidance of jugular venous obstruction, prevention of hyperthermia and hypercarbia) and neurospecific measures. The neurospecific measures are particularly useful in patients with refractory intracranial hypertension. The patient may need sedation, paralysis, use of barbiturate coma, osmotherapy, moderate cooling, controlled hyperventilation or surgical intervention. This review focuses on the rationale for the use of these interventions, outlining their benefits and their pitfalls. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
