Avtor/Urednik		Jeremić, Igor Ante
Naslov		Spremljanje in nadzor znotrajlobanjskega tlaka med zdravljenjem hude možganske poškodbe - funkcija, tehnika in komplikacije
Prevedeni naslov		Intracranial pressure monitoring and follow-up in the course of severe head injury treatment - a role, technique and complications
Tip		članek
Vir		In: Komadina R, Smrkolj V, Pavlovčič V, et al. Zbornik izbranih predavanj Simpozija o poškodbah otroškega skeleta in poškodbah nevrokraniuma in možganov. Celje: Splošna bolnišnica,
Leto izdaje		2009
Obseg		str. 178-89
Jezik		slo
Abstrakt		Increased intracranial pressure (ICP) is a pathologic state common to a variety of neurosurgical conditions and implict finding in patients who have sustained severe traumatic brain injury (TBI). The state of increased intracranial pressure basically results from addition of volume to the intracranial vault. Hence, regardless of injury mechanism, the increase in ICP is fundamental factor of secondary brain damage or brain death through two principal mechanisms (1) global hypoxic-ischemic injury which results from reduction of cerebral perfusion pressure (CPP), and cerebral blood flow (CBF) and (2) mechanical compression, displacement and herniation of brain tissue which results from mass-effect associated with compartmentalised ICP gradients. In the course of immediate and early posttraumatic period those mechanisms tends to progress rapidly, which dictates prompt and vital ICP follow-up and control. Intracranial pressure follow up at present tends to be a founderstone of contemporary neurointensive care in patients with TBI. Today's technology dictates mandatory use of sophicticated transducers and equipment in order to follow-up the pressure in cerebral tissue, ventricular system or in subdural space an continuous linkage with suitable monitoring device. Control of the ICP-namely prevention or therapy of established intracranial hypertension is introduced as a system of conservative (stepwise protocol) or/and surgical procedures by means of external ventricular dreinage (EVD) with siliconised or antibiotic impregnated ventricular (Bactiseal) catheters and in extreme, rare cases of intractable hypertensive crisis by external decompressive craniectomy. Complications determined in the course of ICP control and follow-up pertain singly or jointly to three groups (1) haemorrhage, (2) malfunction, obstruction, malposition and (3) bacterial colonization. (Abs. trunc. at 2000 ch.)
Izvleček		Povečan znotrajlobanjski tlak (ICP) je patološko stanje, značilno za različna nevrokirurška obolenja in brezpogojna ugotovitev pri poškodovancih s hudo možgansko poškodbo. Stanje povečanega ICP v osnovi izhaja iz povečanja volumna v togem prostoru lobanjske votline. Ne glede na mehanizem poškodbe, povečanje ICP je osnovni dejavnik, ki vodi v sekundarno možgansko okvaro ali možgansko smrt preko dveh vodilnih mehanizmov: (1) globalne hipoksično-ishemične okvare, ki izhaja iz znižanja možganskega perfuzijskega pritiska (CPP) in možganskega krvnega pretoka (CBF), in (2)mehaničnega pritiska, premeščanja in herniacije možganskega tkiva, ki rezultira iz mass-efekta, združenega s kompartmentalizacijo ICP gradienta. Neposrednemu in zgodnjemu popoškodbenemu efektu sledi izjemno hiter razvoj teh mehanizmov, kar narekuje življenjsko pomembno spremljanje in nadzor ICP. Spremljanje ICP je danes temeljni kamen sodobne nevrointenzivne terapije poškodovancev s hudo možgansko poškodbo. Današnja tehnologija mandatorno narekuje uporabo sofisticiranih pretvornikov za spremljanje tlaka v možganskem parenhimu, ventrikularnem sistemu in v subduralnem prostoru in kontinuirano povezavo z ustreznim monitorskim aparatom. Nadzor nad ICP - prevenca ali zdravljenje že razvite intrakranialne hipertenzije (ICH) se izvaja konzervativno (stopenjska terapija)in kirurško s pomočjo zunanje ventrikularne drenaže (EVD) s silikonskimi ali antibiotsko impregniranimi (Bactiseal) katetri, redko pa z agresivno dekompresijsko kraniektomijo kot zadnjo možnostjo. Komplikacije, ugotovljene v teku spremljanja in nadzora ICP, sodijo posamično ali združeno v tri skupine (1) krvavitev, (2) motnje lege in delovanja pretvornika in (3) bakterijska kolonizacija. (Izvl. skrajšan na 2000 zn.)
Deskriptorji		INTRACRANIAL PRESSURE BRAIN EDEMA