Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0268318 (ICP)
 10,007 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although there has been concern that a variety of nursing care procedures may serve as potent adaptive demands in patients with intracranial hypertension, research shows that activities such as bathing, oral hygiene, touching, and suctioning produce relatively small increases in ICP and are accompanied by adequate CPP. Head rotation and flexion are potent stimuli to increased ICP, although CPP has remained adequate in the small number of people in whom it has been measured. While considerable descriptive work has been done with respect to a variety of nursing care activities, much remains to be done. Little is known about the mechanisms by which activities (turning and suctioning) effect demands upon the craniospinal system, nor what the best predictors are of individuals who will respond adversely to such demands. The potential of affective touch and environmental sensory stimulation to reduce ICP and reduce the need for potent pharmacologic agents is intriguing but has not been adequately explored. Further investigators need to attend to reporting individual as well as group patterns to guide clinical application and describe predictors of individual response. In addition, the oscillatory nature of ICP and cardiovascular variables needs to be taken into account in interpreting whether or not "real" change has occurred in response to given activities. The full range of cerebrovascular variables needs to be measured to determine if changes in ICP pose a threat to cerebral perfusion. Finally, we need to examine nursing therapeutics with respect to ultimate outcomes (functional recovery) as well as to individual care activities.
 ...
PMID:Intracranial hypertension: influence of nursing care activities. 353 70

The care patients with spinal cord or head injury receive in the acute phase of their injury is critical to outcome. The basics of trauma care are of primary importance to the patient with central nervous system trauma. In the SCI patient, extreme care must be used in establishing an airway. The focus in the head-injured patient is to provide adequate oxygenation and ventilation sufficient to cause hypocarbia. Proper immobilization of the neck is a priority concomitant to establishing an airway in the SCI patient, while control of ICP is a challenge in the head-injured patient. Paramedics, nurses, and physicians who are aware of these important factors in caring for the neurotrauma patient will ensure the patient every chance of functional recovery.
 ...
PMID:Resuscitation of patients with central nervous system trauma. 364 Dec 65

Through the findings in the literature on the basis of 9 personal cases, we review the indications and value of decompressive hemicraniectomy with plasty of the dura mater in cases of medically uncontrolled and decompensated intracranial hypertension. Seven patients had a pseudo-tumoral brain infarction. Five patients survived and their functional recovery is consistent with an autonomous daily life. Another patient with acute traumatic sub-dural haemorrhage died. The ninth patient had presuppurative encephalitis and recovered with no disability. At the time of surgery, all the patients were comatose with herniation of the mesencephalon (n = 3), uncal transtentorial herniation which was either unilateral (n = 4) or bilateral (n = 2). ICP was between 25 and 60 mmHg before the operation. After flap removal, ICP decreased by 15% and, after opening of the dura, it fell a further 70%. In 6 patients we were able to carry out continued post-operative monitoring of ICP, which stayed below 50% of initial values. Decompressive hemicraniectomy is an effective means of treating ICH caused by carotid cerebrovascular accidents with a high degree of edema, where mortality rises to 70-85% when only medical treatment is administered. No haemorrhagic complications, which can occur during hemispherectomies, were observed during decompression.
 ...
PMID:[Evaluation of the clinical benefit of decompression hemicraniectomy in intracranial hypertension not controlled by medical treatment]. 806 88

As part of a prospective study of the cerebrovascular effects of head injury, 54 moderate and severely injured patients underwent 184 133Xe-cerebral blood flow (CBF) studies to determine the relationship between the period of maximum blood flow and outcome. The lowest blood flows were observed on the day of injury (Day 0) and the highest CBFs were documented on postinjury Days 1 to 5. Patients were divided into three groups based on CBF values obtained during this period of maximum flow: Group 1 (seven patients), CBF less than 33 ml/100 g/minute on all determinations; Group 2 (13 patients), CBF both less than and greater than or equal to 33 ml/100 g/minute; and Group 3 (34 patients), CBF greater than or equal to 33 ml/100 g/minute on all measurements. For Groups 1, 2, and 3, mean CBF during Days 1 to 5 postinjury was 25.7 +/- 4, 36.5 +/- 4.2, and 49.4 +/- 9.3 ml/100 g/minute, respectively, and PaCO2 at the time of the CBF study was 31.4 +/- 6, 32.7 +/- 2.9, and 33.4 +/- 4.7 mm Hg, respectively. There were significant differences across Groups 1, 2, and 3 regarding mean age, percentage of individuals younger than 35 years of age (42.9%, 23.1%, and 76.5%, respectively), incidence of patients requiring evacuation of intradural hematomas (57.1%, 38.5%, and 17.6%, respectively) and incidence of abnormal pupils (57.1%, 61.5%, and 32.4%, respectively). Favorable neurological outcome at 6 months postinjury in Groups 1, 2, and 3 was 0%, 46.2%, and 58.8%, respectively (p < 0.05). Further analysis of patients in Group 3 revealed that of 14 with poor outcomes, six had one or more episodes of hyperemia-associated intracranial hypertension (simultaneous CBF > 55 ml/100 g/minute and ICP > 20 mm Hg). These six patients were unique in having the highest CBFs for postinjury Days 1 to 5 (mean 59.8 ml/100 g/minute) and the most severe degree of intracranial hypertension and reduced cerebral perfusion pressure (p < 0.0001). These results indicate that a phasic elevation in CBF acutely after head injury is a necessary condition for achieving functional recovery. It is postulated that for the majority of patients, this rise in blood flow results from an increase in metabolic demands in the setting of intact vasoreactivity. In a minority of individuals, however, the constellation of supranormal CBF, severe intracranial hypertension, and poor outcome indicates a state of grossly impaired vasoreactivity with uncoupling between blood flow and metabolism.
 ...
PMID:Cerebral blood flow as a predictor of outcome following traumatic brain injury. 912 Jun 27