By Allan H. Ropper MD, Daryl R. Gress MD, Michael N. Diringer MD, Deborah M. Green MD, Stephan A. Mayer MD, Thomas P. Bleck MD
The traditional textual content and reference on neurological and neurosurgical in depth care is now in its Fourth Edition–thoroughly revised to include the most recent healing advances and insights from the latest scientific trials. A workforce of individual neuro-intensivists deals useful, state of the art directions for coping with the wide variety of difficulties coming up in postoperative neurosurgical care and care of sufferers with acute neurological ailments. This version focuses sharply at the info of therapeutics. The authors, from major neuro-intensive care devices, have written the booklet jointly, giving it extra cohesiveness and extra of an authoritative consensus voice than prior multiauthored variants.
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Extra info for Neurological and Neurosurgical Intensive Care
Lobectomy Removal of injured or infarcted brain tissue, often combined with some uninjured tissue, has been used in cases in which other measures have failed to effectively reverse intracranial hypertension or tissue shifts. Lobectomy has been advocated as a useful adjuvant in the management of younger patients with relatively higher initial GCS scores who subsequently deteriorate or develop elevated intracranial pressure (139). Case series suggest that aggressive, early temporal lobectomy helps patients with posttraumatic swelling and herniation (140), but, as with hemicraniectomy, appropriate trials are required.
Critical pathway for the treatment of established intracranial hypertension. J Neurotrauma 2000;17:537-538. 6. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Guidelines for cerebral perfusion pressure. J Neurotrauma 2000;17:507-511. 7. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Recommendations for intracranial pressure monitoring technology.
The current approach in patients at risk for elevated ICP or brain tissue shifts (prior to the administration of osmotic dehydrating agents discussed in detail in the following) is to maintain a state of euvolemia with somewhat elevated osmolality. 0% saline) fluids to replace urinary losses, bearing in mind that some free water will be lost through the respiratory system and by diaphoresis. MEDICAL MANAGEMENT OF INTRACRANIAL HYPERTENSION AND TISSUE SHIFTS Sedation A number of sedative medications are effective in reducing ICP.