Monitoring of Patients with Severe Head Injury

Česká verzia

Authors: prof. MUDr. Martin Smrčka, CSc.
Authors place of work: Neurochirurgická klinika LF MU a FN Brno
Published in the journal: Cesk Slov Neurol N 2011; 74/107(1): 9-21
Category: Minimonography

Summary

Head injury is defined as severe in patients with a post-resuscitation Glasgow coma scale (GCS) figure of ≤8. Such patients are relatively deeply unconscious and cannot follow instructions. Therefore we need continuously to monitor those parameters that provide us with important information regarding patient condition and brain function. In recent years, the possibility of monitoring certain cerebral and intracranial function parameters has been added to the routine intensive care watch repertoire of pulse oxymetry, blood pressure, body temperature, laboratory monitoring, central venous pressure, fluid balance, end-tidal CO₂, etc. Monitoring of neurological status, particularly the level of consciousness (GCS) and the pupils is obvious. In terms of invasive intracranial monitoring it is currently practically mandatory that intracranial pressure (ICP) be monitored, either by means of external ventricular drainage or by intraparenchymal probe. As well as this, we monitor cerebral perfusion pressure (CPP). Monitoring of brain tissue oxymetry (PtiO₂) is becoming a standard modality, while microdialysis is also frequent in some departments. CT monitoring is very important to the clinician, particularly in the initial phases after the injury, mainly as an indication for decision-making in certain operative procedures. Individual approaches to multimodal monitoring have to be evaluated in relationship to one another and the patient. Special types of software help us to evaluate the indices of vascular reactivity and this knowledge is currently used to establish the optimal CPP for the individual patient. Monitoring of cerebral physiology should not be purposeless, but should serve for early diagnostics of pathological conditions and at the same time may indicate a correctly performed therapeutical intervention.

Key words:
severe head injury – multimodal monitoring

Zdroje

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