두개 내압 감시 장치를 이용한 두개강 내압 측정에 대한 임상적 연구

구환회,김윤 대한신경외과학회 1986 Journal of Korean neurosurgical society Vol.15 No.1

Continous monitoring of intracranial pressure can be one of the most important physical parameters in assesing patients who have or might develop intracranial hypertension. The author has measured an intracranial epidural pressure by use of a Fiberoptic pressure monitor on 20 cases among brain damaged patients and evaluated it's effect by an epidural pressure change and Glasgow coma scale change after craniectomy and hypertonic solution infusion. Intracranial pressure was compared with signs of increased ICP on brain computed tomography. Also, complications were evaluated. The results are as follows ; 1) Average intracranial pressure was significantly decreased 48㎝ H₂O during the first day after craniectomy. 2) Average intracranial pressure was significantly decreased 33㎝ H₂O after infusion of 10 % glycerol. 3) Improvement of the clinical states after craniectomy was not found in the cases above 20㎝H₂O in spite of decreasing intracranial pressure. 4) Sixteen of seventeen patients showing signs of increased intracranial pressure on brain computed tomography on admission developed elevated intracranial pressure. 5) The infection and intracranial hemorrhage were not found at the monitoring implement site three weeks after removing the intracranial pressure monitor.

두개강내 병소와 동반되는 급성 고혈압의 치료 : 이상적인 항고혈압 치료제의 선택을 중심으로 Focus on Selecting Ideal Antibypertensive Agents

박정율,이자규,이일옥,공명훈,송우혁,정흥섭,이기찬,이훈갑 고려대학교 의과대학 1997 고려대 의대 잡지 Vol.34 No.2

Patients with acute hypertension associated with intracranial pathology often require prompt reduction of elevated blood pressure. But the principal goal here is to ameliorate systemic hypertension while maintaining adequate cerebral perfusion pressure to provide required cerebral blood flow and thereby preventing secondary ischemic brain damage. Although many new antihypertensive agents are now available, the ideal agent along with optimal guidelines for blood pressure reduction still remain controversial in acute hypertensive patients with different types of intracranial pathologies. Object of this study was to first review briefly the cerebrovascular pathophysiology of hypertension in conjunction with management of these patients. Pertinent literature is searched, indexed, and referenced from MEDLINE for this purpose. From this information, along with clinical experiences, authors tried to provide some of basic guidelines for managing these patients in various clinical situations, focusing mainly on selecting ideal antihypertensive agents available at present time. From the present standpoint it is generally agreed that 1- or 1-adrenergic receptor antagonists provide arterial pressure reduction with little or no adverse effect on intracranial pressure within regulatory range. Although many promising calcium-channel blocking agents are now available, their use are often limited by their action to cause cerebral vasodilation and thus increased intracranial pressure. Angiotensin converting enzyme inhibitors can be used for moderate hypertension but have potential to further increase intracranial pressure in patients who already have intracranial hypertension. It has long been known that barbiturates can be adjuvant method in case of resistant or malignant hypertension with intractablly increased intracranial pressure since it decreases both the blood pressure and cerebral blood flow with reduction of oxygen metabolism. The proper management of acute hypertension in the patients with intracranial pathology should be based on sufficient understanding of the pathophysiology of hypertension and cerebral perfusion pressure. Ideal agents would be individually based on their ability to promptly and reliably ameliorate the hypertension and at the same time maintain adequate cerebral blood flow and intracranial pressure.

두개강내압 측정시 경막외 측정치와 뇌실내 측정치와의 비교분석

유도성,김달수,조경석,박춘근,강준기 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.6

두위변동에 따른 생체징후, 뇌관류압 및 뇌압의 변화에 관하여

지용철,배장호,한동로,도은식,김오룡,최병연,조수호 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.5

Intracranial pressure was monitored in 23 patients, either who exhibited an increase in pressure or who were considered at risk for the development of intracranial hypertention. The intracranial pressure was measured while the patient was in the position from supine to 50 degree of head elevation. The intracranial pressure was decreased during head elevation, but 8 cases(34.8%) were not changed. The maximal cerebral perfusion pressure was seen at 50 degree of head elevation(52.2%), next 30 degree(21.7%) and 40 degree(17.4%) in orders. The changes of vital sign were not significant during head elevation. To control the intracranial pressure, the patient who where managed in the position of 30° and 50° head elevation showed most effective cerebral perfusion pressure without any significant changes of the vital sing and central venous pressure.

Critical Care Management and Monitoring of Intracranial Pressure

Jeremy Ragland,Kiwon Lee 대한신경집중치료학회 2016 대한신경집중치료학회지 Vol.9 No.2

Patients with brain injury of any etiology are at risk for developing increased intracranial pressure. Acute intracranial hypertension is a medical emergency requiring immediate intervention to prevent permanent damage to the brain. Intracranial pressure as an absolute value is not as valuable as when one investigates other important associated variables such as cerebral perfusion pressure and contributing factors for an adequate cerebral blood flow. This manuscript reviews a number of various interventions that can be used to treat acute intracranial hypertension and optimize cerebral perfusion pressure. Management options are presented in an algorithm-format focusing on current treatment strategies and treatment goals. In addition to the efficacy, clinicians must consider significant adverse events that are associated with each therapy prior to initiating treatment. The initial step includes elevation of head of the bed and adequate sedation followed by osmotic agents such as mannitol and hypertonic saline infusion. Hypothermia and pentobarbital therapy represent more aggressive steps, and utilize different mechanisms by which the pressure is controlled, likely causing significant reduction in metabolism. Surgical intervention may precede any medical therapy in order to provide more robust response in controlling intracranial hypertension in certain cases.

뇌부종과 두개내압 조절을 위한 뇌관류압 최적화 치료

김태정,고상배 대한의사협회 2023 대한의사협회지 Vol.66 No.5

Background: Increased intracranial pressure (ICP) is a pathological condition associated with severe neurological conditions in patients with acute brain injuries. Managing increased ICP based on optimal cerebral perfusion pressure (CPP) is crucial for improving outcomes. Current Concepts: Cerebral autoregulation, the intrinsic ability to maintain stable cerebral blood flow across a wide range of CPP, is impaired in several brain injuries. CPP, the difference between the mean arterial pressure and the ICP, is a critical factor in maintaining cerebral blood flow. Therefore, optimal CPP is important in managing patients with acute brain injuries. In addition, monitoring cerebral autoregulation and its response to pathological derangements can help diagnose, manage, and predict acute brain injury outcomes. Goal-directed therapy using cerebral autoregulation is beneficial in managing patients with ICP elevation. If blood pressure is excessively low in a patient with elevated intracranial pressure, a treatment to increase blood pressure should be considered as a first step, called optimizing cerebral perfusion pressure. However, if CPP is excessively high in a patient with elevated ICP, a treatment to lower CPP by controlling blood pressure to an appropriate level to prevent worsening of edema due to hyperperfusion should be considered. Discussion and Conclusion: Monitoring cerebral autoregulation to guide optimal management of increased ICP based on optimal CPP may be helpful in goal-directed therapy and improving prognosis among patients with acute brain injuries.

두개내압 상승을 반복할 때의 가토혈압상승과 중추 α-adrenoceptor와의 관계

장석정,도성신,박승규,신호,김봉환 대한신경외과학회 1985 Journal of Korean neurosurgical society Vol.14 No.2

Urethane 마취 가토에서 경뇌막외강네 balloon 방법을 통하여 가압(가압 balloon내 식염수 주입속도 0.058/min)에 의한 cushing반응(이를 일차가압 실험이라 함)을 관찰한 다음 즉시 가압 balloon내 주입되었던 식염수를 일시에 제거한 후 30~60분을 기다려 다시 가압실험(이를 이차가압 실험이라 함)을 실시하면 더욱 급격한 cushing반응이 나타났다. 이 이차가압실험에 있어서의 cushing반응에 대한 몇가지 자율신경계 약물의 효과를 조사하였다. 1) 일차가압 실험 시작시의 내압은 26±0.9 ㎜Hg, 혈압은 105±3.1 ㎜Hg 심박은 245±5.7 beats/min이였다. 일차가압실험에서는 가압초기에 내압의 상승에 따라 혈압은 현저한 상승을 보이고 심박은 감소하였다. 최고혈압 상승시에 내압은 165±9.2 ㎜Hg, 원혈압에 대한 혈압 상승율은 49±4.7%, 원심박에 대한 심박 감소율은 16±2.9%, 식염수 주입량은 1.20±0.2 ㎖였다. 2) 이차가압실험 시작시의 내압은 33±1.4 ㎜Hg, 혈압은 84±2.8 ㎜Hg, 심박은 213±6.3 beats/min였다. 이차가압실험에서는 일차가압실험의 가압초기에 나타났던 경미한 혈압 하강을 볼 수 없었고, 급격한 혈압 상승을 일으켰다. 최고혈압상승시의 내압은 137±11.5 ㎜Hg, 혈압 상승율은 71±6.6%, 심박 감소는 거의 없었고 식염수 주입량은 0.52±0.1 ㎖였다. 3) 정맥내 chlorisondamine은 이차 가압에 의한 cushing반응을 억제하였다. 4) 측뇌강내 corynanthine 투여는 일차가압에 의한 coshing반응에는 거의 영향을 주지 못하였으나 이차가압에 의한 cushing반응은 억제하였다. 5) 측뇌실내 clonidine, yohimbine 및 prazosim은 이차가압에 의한 cushing반응에 거의 영향을 미치지 못하였다. 이상의 성적으로 가토에서 일차가압에 의한 cushing 반응후에는 중추 α₂-adrenoceptor의 기능저하가 일어나며, 이차가압에 의한 cushing반응에는 중추 α₁-adrenoceptor가 중요한 역활을 하고 있는 것으로 추론 하였다. It is well documented that elevation of intracranial pressure is accompanied by arterial blood pressure (cushing response) in laboratory animals as well as in human. When the elevation of intracranial pressure (ICP) was repeated in a rabbit at an interval of 30-60 min, the blood pressure increased more promtly than in the First elevation of ICP, suggesting that mechanism involved in the pressure might be different. Therefore, this study was undertaken to clarify the pharmacological characteristics of the response to the first and repeated (second) elevation of ICP in urethane anesthetized rabbits. Increasing ICP, induced by infusion of saline into a ballooned in the epidural space, produced arise of the arterial blood pressure. When the blood pressure reached a peak, the ballon was suddenly deflated to reduce the ICP and blood pressure declined (the first ICP evevation experiment). After 30-60 min the same procedure was repeated (the second ICP-elevation experiment) Results are summarized as follows; 1) In the first ICP elevation experiment, the arise of ICP was relatively slow at the beginning of the infusion but became sharp as the infusion proceeded. Coinciding with the gradual increase of ICP, there was a slight decrease in BP When ICP increased sharply BP also increased abruptly and heart rate decreased. 2) In the second ICP elevation experiment, the slight decrease in BP which appeard at the begining of the first ICP elevation experiment rat observed, so that only an abrupt arise of BP was seen. 3) Intravenous chlorisondamine inhibited the pressure responses in the second ICP elevation experiment. 4) Intraventricular corynanthine had little effect on the pressure response to the first ICP elevaton but inhibited the pressure response to the second ICP elevation. 5) Intraventricular clonidine, yohimbine and prazosin little effect on the pressure response to the second ICP elevation. From this results that functional integrity of central α₂-adrenoceptor which took part in the pressure response to the first ICP elevation might have deranged in the second ICP elevation and that central α₁-adrenoceptors play a dominant role in the pressure response to the second ICP elevation.

뇌부종과 두개내압 조절을 위한 고삼투압 치료

곽동석,고상배 대한의사협회 2023 대한의사협회지 Vol.66 No.5

Background: Hyperosmolar therapy is an essential treatment method for increased intracranial pressure and cerebral edema. Mannitol and hypertonic saline are frequently used in clinical practice; however, more helpful recommendations are needed for the optimal management of cerebral edema in terms of the choice, dosage, and timing of these medications. This study aimed to introduce the characteristics and relative strengths of two agents, i.e., mannitol and hypertonic saline, and review clinical data supporting their use in various diseases. Current Concepts: Hyperosmolar therapy reduces intracranial pressure by removing water from the brain tissue and transferring it to the vascular space by creating an osmotic gradient. Mannitol improves cerebral blood flow by reducing the hematocrit, decreasing blood viscosity, and increasing deformability of red blood cells. Hypertonic saline increases intravascular volume, transiently increases cardiac output, and improves tissue oxygen partial pressure in the brain. Hypertonic saline has several advantages over mannitol, including quicker onset and longer-lasting reduction in intracranial pressure. However, no significant differences are noted in clinical, functional outcomes, or mortality between the two treatment agents. Discussion and Conclusion: Both mannitol and hypertonic saline are effective in reducing increased intracranial pressure. Clinicians should be able to select an appropriate agent in different clinical situations based on available evidence and patients’ individual medical conditions.

Intracranial Pressure Monitoring for Acute Brain Injured Patients: When, How, What Should We Monitor

Youngbo Shim,Jungook Kim,Hye Seon Kim,Jiwoong Oh,Seungjoo Lee,Eun Jin Ha 대한신경손상학회 2023 Korean Journal of Neurotrauma Vol.19 No.2

While there is no level I recommendation for intracranial pressure (ICP) monitoring, it is typically indicated for patients with severe traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) score of 3–8 (class II). Even for moderate TBI patients with GCS 9–12, ICP monitoring should be considered for risk of increased ICP. The impact of ICP monitoring on patient outcomes is still not well-established, but recent studies reported a reduction of early mortality (class III) in TBI patients. There is no standard protocol for the application of ICP monitoring. In cases where cerebrospinal fluid drainage is required, an external ventricular drain is commonly used. In other cases, parenchymal ICP monitoring devices are generally employed. Subdural or non-invasive forms are not suitable for ICP monitoring. The mean value of ICP is the parameter recommended for observation in many guidelines. In TBI, values above 22 mmHg are associated with increased mortality. However, recent studies proposed various parameters including cumulative time with ICP above 20 mmHg (pressure-time dose), pressure reactivity index, ICP waveform characteristics (pulse amplitude of ICP, mean ICP wave amplitude), and the compensatory reserve of the brain (reserve-amplitude-pressure), which are useful in predicting patient outcomes and guiding treatment. Further research is required for validation of these parameters compared to simple ICP monitoring.

Increased intracranial pressure after massive blood loss -A case report-

박지현,전인구,손효정,곽미정 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.2

A 4-year old boy with supravalvular ascending aortic stenosis underwent sliding aortoplasty. After cardiopulmonary bypass weaning, aorta suture site was torn accidentally and the patient was in hypovolemic shock. Emergency cardiopulmonary bypass was reinstituted and the aorta was repaired. After removal of the aortic clamp, bradycardia and hypertension were noted. We suspected increased intracranial pressure due to hypoxic brain damage after massive blood loss and the patient was treated to lower the intracranial pressure. Physicians should be aware of the significance of the hemodynamic change associated with increased intracranial pressure to prevent further neurologic damage.