Neurocritical Care
Core concepts
Manage the brain-injured patient in the ICU: airway protection, blood pressure targets, sedation, temperature control, and prevention of secondary injury. Understand cerebral perfusion pressure and the relationship between mean arterial pressure and intracranial pressure. Know seizure management and status epilepticus protocols.
Monitoring and support
- ICP monitoring indications and waveform basics.
- CPP = MAP minus ICP; targets vary by condition.
- Osmotherapy with mannitol or hypertonic saline for elevated ICP.
- Avoid hypoxia and hypotension, which worsen outcomes.
- Fever control and glucose management.
Traps
- Lowering blood pressure aggressively in an ischemic or injured brain.
- Missing nonconvulsive status epilepticus in a persistently altered patient.
- Overlooking hyponatremia causes (SIADH versus cerebral salt wasting).
- Forgetting that hyperventilation is a bridge, not a treatment.
Worked example
A patient with severe TBI and rising ICP: ensure sedation and analgesia, elevate the head, maintain CPP, and use osmotherapy; reserve hyperventilation for impending herniation. Rule of thumb: protect the brain by protecting perfusion - avoid hypotension above all.
Study strategy
Practice CPP calculations and link each intervention to its physiologic rationale. Review sodium disorders in neurocritical illness.