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Erschienen in: Neurocritical Care 1/2012

01.09.2012 | Review Article

Emergency Neurological Life Support: Intracranial Hypertension and Herniation

verfasst von: Robert D. Stevens, J. Stephen Huff, Josh Duckworth, Alexander Papangelou, Scott D. Weingart, Wade S. Smith

Erschienen in: Neurocritical Care | Sonderheft 1/2012

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Abstract

Sustained intracranial hypertension and acute brain herniation are “brain codes,” signifying catastrophic neurological events that require immediate recognition and treatment to prevent irreversible injury and death. As in cardiac arrest, evidence supports the organized implementation of a stepwise management algorithm. Because there are multiple etiologies and many treatments that can potentially reverse cerebral herniation, intracranial hypertension and herniation was chosen as an Emergency Neurological Life Support (ENLS) protocol.
Literatur
1.
Zurück zum Zitat Monro A. Observations on the structure and functions of the nervous system. Edinburgh: Printed for, and sold by, W. Creech; 1783. Monro A. Observations on the structure and functions of the nervous system. Edinburgh: Printed for, and sold by, W. Creech; 1783.
2.
Zurück zum Zitat Kellie G. Appearances observed in the dissection of two individuals; death from cold and congestion of the brain. Trans Med Chir Soc Edinburgh. 1824;1:84. Kellie G. Appearances observed in the dissection of two individuals; death from cold and congestion of the brain. Trans Med Chir Soc Edinburgh. 1824;1:84.
3.
Zurück zum Zitat Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, et al. Guidelines for the management of severe traumatic brain injury. VIII. Intracranial pressure thresholds. J Neurotrauma. 2007;24 Suppl 1:S55–8. Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, et al. Guidelines for the management of severe traumatic brain injury. VIII. Intracranial pressure thresholds. J Neurotrauma. 2007;24 Suppl 1:S55–8.
4.
Zurück zum Zitat Cushing H. Concerning a definite regulatory mechanism of the vasomotor centre which controls blood pressure during cerebral compression. Bull Johns Hopkins Hosp. 1901;126:289–92. Cushing H. Concerning a definite regulatory mechanism of the vasomotor centre which controls blood pressure during cerebral compression. Bull Johns Hopkins Hosp. 1901;126:289–92.
5.
Zurück zum Zitat Meyer A. Herniation of the brain. Arch Neurol Psychiatry. 1920;4:387–400. Meyer A. Herniation of the brain. Arch Neurol Psychiatry. 1920;4:387–400.
6.
Zurück zum Zitat Ropper AH. Lateral displacement of the brain and level of consciousness in patients with an acute hemispheral mass. N Engl J Med. 1986;314:953–8.CrossRefPubMed Ropper AH. Lateral displacement of the brain and level of consciousness in patients with an acute hemispheral mass. N Engl J Med. 1986;314:953–8.CrossRefPubMed
7.
Zurück zum Zitat Kernohan JW, Woltman HW. Incisura of the crus due to contralateral brain tumour. Arch Neurol Psychiatry. 1929;21:274–87. Kernohan JW, Woltman HW. Incisura of the crus due to contralateral brain tumour. Arch Neurol Psychiatry. 1929;21:274–87.
8.
Zurück zum Zitat Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, et al. Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma. 2007;24 Suppl 1:S37–44. Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, et al. Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma. 2007;24 Suppl 1:S37–44.
9.
Zurück zum Zitat Contant CF, Valadka AB, Gopinath SP, Hannay HJ, Robertson CS. Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury. J Neurosurg. 2001;95:560–8.CrossRefPubMed Contant CF, Valadka AB, Gopinath SP, Hannay HJ, Robertson CS. Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury. J Neurosurg. 2001;95:560–8.CrossRefPubMed
10.
Zurück zum Zitat Feldman Z, Kanter MJ, Robertson CS, et al. Effect of head elevation on intracranial pressure, cerebral perfusion pressure, and cerebral blood flow in head-injured patients. J Neurosurg. 1992;76:207–11.CrossRefPubMed Feldman Z, Kanter MJ, Robertson CS, et al. Effect of head elevation on intracranial pressure, cerebral perfusion pressure, and cerebral blood flow in head-injured patients. J Neurosurg. 1992;76:207–11.CrossRefPubMed
11.
Zurück zum Zitat Ng I, Lim J, Wong HB. Effects of head posture on cerebral hemodynamics: its influences on intracranial pressure, cerebral perfusion pressure, and cerebral oxygenation. Neurosurgery. 2004;54:593–7: Discussion: 8.CrossRefPubMed Ng I, Lim J, Wong HB. Effects of head posture on cerebral hemodynamics: its influences on intracranial pressure, cerebral perfusion pressure, and cerebral oxygenation. Neurosurgery. 2004;54:593–7: Discussion: 8.CrossRefPubMed
12.
Zurück zum Zitat Galicich JH, French LA, Melby JC. Use of dexamethasone in treatment of cerebral edema associated with brain tumors. J Lancet. 1961;81:46–53.PubMed Galicich JH, French LA, Melby JC. Use of dexamethasone in treatment of cerebral edema associated with brain tumors. J Lancet. 1961;81:46–53.PubMed
13.
Zurück zum Zitat Quartey GR, Johnston JA, Rozdilsky B. Decadron in the treatment of cerebral abscess. An experimental study. J Neurosurg. 1976;45:301–10.CrossRefPubMed Quartey GR, Johnston JA, Rozdilsky B. Decadron in the treatment of cerebral abscess. An experimental study. J Neurosurg. 1976;45:301–10.CrossRefPubMed
14.
Zurück zum Zitat Kerr EM, Marion D, Sereika MS, et al. The effect of cerebrospinal fluid drainage on cerebral perfusion in traumatic brain injured adults. J Neurosurg Anesthesiol. 2000;12:324–33.CrossRefPubMed Kerr EM, Marion D, Sereika MS, et al. The effect of cerebrospinal fluid drainage on cerebral perfusion in traumatic brain injured adults. J Neurosurg Anesthesiol. 2000;12:324–33.CrossRefPubMed
15.
Zurück zum Zitat Francony G, Fauvage B, Falcon D, et al. Equimolar doses of mannitol and hypertonic saline in the treatment of increased intracranial pressure. Crit Care Med. 2008;36:795–800.CrossRefPubMed Francony G, Fauvage B, Falcon D, et al. Equimolar doses of mannitol and hypertonic saline in the treatment of increased intracranial pressure. Crit Care Med. 2008;36:795–800.CrossRefPubMed
16.
Zurück zum Zitat Coles JP, Minhas PS, Fryer TD, et al. Effect of hyperventilation on cerebral blood flow in traumatic head injury: clinical relevance and monitoring correlates. Crit Care Med. 2002;30:1950–9.CrossRefPubMed Coles JP, Minhas PS, Fryer TD, et al. Effect of hyperventilation on cerebral blood flow in traumatic head injury: clinical relevance and monitoring correlates. Crit Care Med. 2002;30:1950–9.CrossRefPubMed
17.
Zurück zum Zitat Muizelaar JP, Marmarou A, Ward JD, et al. Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg. 1991;75:731–9.CrossRefPubMed Muizelaar JP, Marmarou A, Ward JD, et al. Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg. 1991;75:731–9.CrossRefPubMed
18.
Zurück zum Zitat Eberle BM, Schnuriger B, Inaba K, Gruen JP, Demetriades D, Belzberg H. Decompressive craniectomy: surgical control of traumatic intracranial hypertension may improve outcome. Injury. 2010;41:894–8.CrossRefPubMed Eberle BM, Schnuriger B, Inaba K, Gruen JP, Demetriades D, Belzberg H. Decompressive craniectomy: surgical control of traumatic intracranial hypertension may improve outcome. Injury. 2010;41:894–8.CrossRefPubMed
19.
Zurück zum Zitat Johnson RD, Maartens NF, Teddy PJ. Decompressive craniectomy for malignant middle cerebral artery infarction: evidence and controversies. J Clin Neurosci. 2011;18:1018–22.CrossRefPubMed Johnson RD, Maartens NF, Teddy PJ. Decompressive craniectomy for malignant middle cerebral artery infarction: evidence and controversies. J Clin Neurosci. 2011;18:1018–22.CrossRefPubMed
20.
Zurück zum Zitat Bulger EM, May S, Brasel KJ, et al. Out-of-hospital hypertonic resuscitation following severe traumatic brain injury: a randomized controlled trial. JAMA. 2012;304:1455–64.CrossRef Bulger EM, May S, Brasel KJ, et al. Out-of-hospital hypertonic resuscitation following severe traumatic brain injury: a randomized controlled trial. JAMA. 2012;304:1455–64.CrossRef
21.
Zurück zum Zitat Dubick MA, Wade CE. A review of the efficacy and safety of 7.5 % NaCl/6 % dextran 70 in experimental animals and in humans. J Trauma. 1994;36:323–30.CrossRefPubMed Dubick MA, Wade CE. A review of the efficacy and safety of 7.5 % NaCl/6 % dextran 70 in experimental animals and in humans. J Trauma. 1994;36:323–30.CrossRefPubMed
22.
Zurück zum Zitat Koenig MA, Bryan M, Lewin JL 3rd, Mirski MA, Geocadin RG, Stevens RD. Reversal of transtentorial herniation with hypertonic saline. Neurology. 2008;70:1023–9.CrossRefPubMed Koenig MA, Bryan M, Lewin JL 3rd, Mirski MA, Geocadin RG, Stevens RD. Reversal of transtentorial herniation with hypertonic saline. Neurology. 2008;70:1023–9.CrossRefPubMed
23.
Zurück zum Zitat Kelly DF, Goodale DB, Williams J, et al. Propofol in the treatment of moderate and severe head injury: a randomized, prospective double-blinded pilot trial. J Neurosurg. 1999;90:1042–52.CrossRefPubMed Kelly DF, Goodale DB, Williams J, et al. Propofol in the treatment of moderate and severe head injury: a randomized, prospective double-blinded pilot trial. J Neurosurg. 1999;90:1042–52.CrossRefPubMed
24.
Zurück zum Zitat Roberts RJ, Barletta JF, Fong JJ, et al. Incidence of propofol-related infusion syndrome in critically ill adults: a prospective, multicenter study. Crit Care. 2009;13:R169.CrossRefPubMed Roberts RJ, Barletta JF, Fong JJ, et al. Incidence of propofol-related infusion syndrome in critically ill adults: a prospective, multicenter study. Crit Care. 2009;13:R169.CrossRefPubMed
25.
Zurück zum Zitat Fong JJ, Sylvia L, Ruthazer R, Schumaker G, Kcomt M, Devlin JW. Predictors of mortality in patients with suspected propofol infusion syndrome. Crit Care Med. 2008;36:2281–7.CrossRefPubMed Fong JJ, Sylvia L, Ruthazer R, Schumaker G, Kcomt M, Devlin JW. Predictors of mortality in patients with suspected propofol infusion syndrome. Crit Care Med. 2008;36:2281–7.CrossRefPubMed
26.
Zurück zum Zitat Mendelow AD, Gregson BA, Fernandes HM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005;365:387–97.PubMed Mendelow AD, Gregson BA, Fernandes HM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005;365:387–97.PubMed
27.
Zurück zum Zitat Pfefferkorn T, Eppinger U, Linn J, et al. Long-term outcome after suboccipital decompressive craniectomy for malignant cerebellar infarction. Stroke. 2009;40:3045–50.CrossRefPubMed Pfefferkorn T, Eppinger U, Linn J, et al. Long-term outcome after suboccipital decompressive craniectomy for malignant cerebellar infarction. Stroke. 2009;40:3045–50.CrossRefPubMed
28.
Zurück zum Zitat Raco A, Caroli E, Isidori A, Salvati M. Management of acute cerebellar infarction: one institution’s experience. Neurosurgery. 2003;53:1061–5: Discussion: 5–6.CrossRefPubMed Raco A, Caroli E, Isidori A, Salvati M. Management of acute cerebellar infarction: one institution’s experience. Neurosurgery. 2003;53:1061–5: Discussion: 5–6.CrossRefPubMed
29.
Zurück zum Zitat Jiang JY, Xu W, Li WP, et al. Efficacy of standard trauma craniectomy for refractory intracranial hypertension with severe traumatic brain injury: a multicenter, prospective, randomized controlled study. J Neurotrauma. 2005;22:623–8.CrossRefPubMed Jiang JY, Xu W, Li WP, et al. Efficacy of standard trauma craniectomy for refractory intracranial hypertension with severe traumatic brain injury: a multicenter, prospective, randomized controlled study. J Neurotrauma. 2005;22:623–8.CrossRefPubMed
30.
Zurück zum Zitat Olivecrona M, Rodling-Wahlstrom M, Naredi S, Koskinen LO. Effective ICP reduction by decompressive craniectomy in patients with severe traumatic brain injury treated by an ICP-targeted therapy. J Neurotrauma. 2007;24:927–35.CrossRefPubMed Olivecrona M, Rodling-Wahlstrom M, Naredi S, Koskinen LO. Effective ICP reduction by decompressive craniectomy in patients with severe traumatic brain injury treated by an ICP-targeted therapy. J Neurotrauma. 2007;24:927–35.CrossRefPubMed
31.
Zurück zum Zitat Taylor A, Butt W, Rosenfeld J, et al. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst. 2001;17:154–62.CrossRefPubMed Taylor A, Butt W, Rosenfeld J, et al. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst. 2001;17:154–62.CrossRefPubMed
32.
Zurück zum Zitat Cooper DJ, Rosenfeld JV, Murray L, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364:1493–502.CrossRefPubMed Cooper DJ, Rosenfeld JV, Murray L, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364:1493–502.CrossRefPubMed
33.
Zurück zum Zitat Hofmeijer J, Kappelle LJ, Algra A, et al. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol. 2009;8:326–33.CrossRefPubMed Hofmeijer J, Kappelle LJ, Algra A, et al. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol. 2009;8:326–33.CrossRefPubMed
34.
Zurück zum Zitat Vahedi K, Hofmeijer J, Juettler E, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007;6:215–22.CrossRefPubMed Vahedi K, Hofmeijer J, Juettler E, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007;6:215–22.CrossRefPubMed
35.
Zurück zum Zitat Brain Trauma Foundation. The use of barbiturates in the control of intracranial hypertension. J Neurotrauma. 1996;13:711–4.CrossRef Brain Trauma Foundation. The use of barbiturates in the control of intracranial hypertension. J Neurotrauma. 1996;13:711–4.CrossRef
36.
Zurück zum Zitat Eisenberg HM, Frankowski RF, Contant CF, Marshall LF, Walker MD. High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg. 1988;69:15–23.CrossRefPubMed Eisenberg HM, Frankowski RF, Contant CF, Marshall LF, Walker MD. High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg. 1988;69:15–23.CrossRefPubMed
37.
Zurück zum Zitat Perez-Barcena J, Llompart-Pou JA, Homar J, et al. Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled trial. Crit Care. 2008;12:R112.CrossRefPubMed Perez-Barcena J, Llompart-Pou JA, Homar J, et al. Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled trial. Crit Care. 2008;12:R112.CrossRefPubMed
38.
Zurück zum Zitat Jiang J, Yu M, Zhu C. Effect of long-term mild hypothermia therapy in patients with severe traumatic brain injury: 1-year follow-up review of 87 cases. J Neurosurg. 2000;93:546–9.CrossRefPubMed Jiang J, Yu M, Zhu C. Effect of long-term mild hypothermia therapy in patients with severe traumatic brain injury: 1-year follow-up review of 87 cases. J Neurosurg. 2000;93:546–9.CrossRefPubMed
39.
Zurück zum Zitat Liu WG, Qiu WS, Zhang Y, Wang WM, Lu F, Yang XF. Effects of selective brain cooling in patients with severe traumatic brain injury: a preliminary study. J Int Med Res. 2006;34:58–64.PubMed Liu WG, Qiu WS, Zhang Y, Wang WM, Lu F, Yang XF. Effects of selective brain cooling in patients with severe traumatic brain injury: a preliminary study. J Int Med Res. 2006;34:58–64.PubMed
40.
Zurück zum Zitat Marion DW, Obrist WD, Carlier PM, Penrod LE, Darby JM. The use of moderate therapeutic hypothermia for patients with severe head injuries: a preliminary report. J Neurosurg. 1993;79:354–62.CrossRefPubMed Marion DW, Obrist WD, Carlier PM, Penrod LE, Darby JM. The use of moderate therapeutic hypothermia for patients with severe head injuries: a preliminary report. J Neurosurg. 1993;79:354–62.CrossRefPubMed
41.
Zurück zum Zitat Marion DW, Penrod LE, Kelsey SF, et al. Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med. 1997;336:540–6.CrossRefPubMed Marion DW, Penrod LE, Kelsey SF, et al. Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med. 1997;336:540–6.CrossRefPubMed
42.
Zurück zum Zitat Qiu W, Zhang Y, Sheng H, et al. Effects of therapeutic mild hypothermia on patients with severe traumatic brain injury after craniotomy. J Crit Care. 2007;22:229–35.CrossRefPubMed Qiu W, Zhang Y, Sheng H, et al. Effects of therapeutic mild hypothermia on patients with severe traumatic brain injury after craniotomy. J Crit Care. 2007;22:229–35.CrossRefPubMed
43.
Zurück zum Zitat Shiozaki T, Sugimoto H, Taneda M, et al. Effect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury. J Neurosurg. 1993;79:363–8.CrossRefPubMed Shiozaki T, Sugimoto H, Taneda M, et al. Effect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury. J Neurosurg. 1993;79:363–8.CrossRefPubMed
44.
Zurück zum Zitat Chang JJ, Youn TS, Benson D, et al. Physiologic and functional outcome correlates of brain tissue hypoxia in traumatic brain injury. Crit Care Med. 2009;37:283–90.CrossRefPubMed Chang JJ, Youn TS, Benson D, et al. Physiologic and functional outcome correlates of brain tissue hypoxia in traumatic brain injury. Crit Care Med. 2009;37:283–90.CrossRefPubMed
45.
Zurück zum Zitat Longhi L, Pagan F, Valeriani V, et al. Monitoring brain tissue oxygen tension in brain-injured patients reveals hypoxic episodes in normal-appearing and in peri-focal tissue. Intensive Care Med. 2007;33:2136–42.CrossRefPubMed Longhi L, Pagan F, Valeriani V, et al. Monitoring brain tissue oxygen tension in brain-injured patients reveals hypoxic episodes in normal-appearing and in peri-focal tissue. Intensive Care Med. 2007;33:2136–42.CrossRefPubMed
46.
Zurück zum Zitat Chen HI, Stiefel MF, Oddo M, et al. Detection of cerebral compromise with multimodality monitoring in patients with subarachnoid hemorrhage. Neurosurgery. 2011;69:53–63: Discussion.CrossRefPubMed Chen HI, Stiefel MF, Oddo M, et al. Detection of cerebral compromise with multimodality monitoring in patients with subarachnoid hemorrhage. Neurosurgery. 2011;69:53–63: Discussion.CrossRefPubMed
47.
Zurück zum Zitat Schmidt B, Czosnyka M, Raabe A, et al. Adaptive noninvasive assessment of intracranial pressure and cerebral autoregulation. Stroke. 2003;34:84–9.CrossRefPubMed Schmidt B, Czosnyka M, Raabe A, et al. Adaptive noninvasive assessment of intracranial pressure and cerebral autoregulation. Stroke. 2003;34:84–9.CrossRefPubMed
48.
Zurück zum Zitat Brady K, Joshi B, Zweifel C, et al. Real-time continuous monitoring of cerebral blood flow autoregulation using near-infrared spectroscopy in patients undergoing cardiopulmonary bypass. Stroke. 2010;41:1951–6.CrossRefPubMed Brady K, Joshi B, Zweifel C, et al. Real-time continuous monitoring of cerebral blood flow autoregulation using near-infrared spectroscopy in patients undergoing cardiopulmonary bypass. Stroke. 2010;41:1951–6.CrossRefPubMed
Metadaten
Titel
Emergency Neurological Life Support: Intracranial Hypertension and Herniation
verfasst von
Robert D. Stevens
J. Stephen Huff
Josh Duckworth
Alexander Papangelou
Scott D. Weingart
Wade S. Smith
Publikationsdatum
01.09.2012
Verlag
Humana Press Inc
Erschienen in
Neurocritical Care / Ausgabe Sonderheft 1/2012
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-012-9754-5

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