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Management of Cerebral Oedema

Management of Cerebral Oedema. By: Gill, Catherine, Donna, Sharon . Cerebral Oedema. This is an excess accumulation of water in the intra- and/or extra cellular spaces of the brain.

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Management of Cerebral Oedema

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  1. Management of Cerebral Oedema By: Gill, Catherine, Donna, Sharon

  2. Cerebral Oedema • This is an excess accumulation of water in the intra- and/or extra cellular spaces of the brain. • Oedema can occur as the result of many things, including head injury, allergic reaction, stroke, acute liver disease, cardiac arrest or from the lack of proper altitude acclimatization.

  3. Management of Cerebral Oedema • Clinical signs of cerebral oedema begin to appear when the intracranial pressure exceeds 30mm Hg. • Failure to arrest the process results in respiratory arrest from brainstem coning. • If left untreated, it can lead to death.

  4. Management Osmotherapy • The most rapid and effective means of decreasing tissue water and brain bulk is osmotherapy • Osmotic therapy is intended to draw water out of the brain by an osmotic gradient and help to decrease blood viscosity. • These changes would decrease ICP and increase cerebral blood flow (CBF).

  5. Management • Osmotic diuretics may reduce intracranial pressure in patients with reduced level of consciousness and raised intracranial pressure, but are short-lasting and often ineffective • Infusions may be repeated provided plasma osmolarity does not exceed 320mOsm.

  6. Cont: Management • Mannitol is the most popular osmotic agent. • Mannitol is thought to decrease brain volume by decreasing overall water content, and to reduce blood volume by vasoconstriction, to reduce CSF volume by decreasing water content. Mannitol may also improve cerebral perfusion by decreasing viscosity or altering red blood cell rheology. • Lastly mannitol may exert a protective effect against biochemical injury.

  7. Management • Positioning: Patients may be positioned with the head at no more than 30 degrees to the horizontal. Further elevation seems to produce a paradoxical increase in intracranial pressure. • Blood pressure needs to be monitored carefully in cases with cerebral edema. • Fluid restriction minimally affects cerebral edema and, if pursued to excess, may result in episodes of hypotension, which may increase ICP andis associated with worse neurologic outcome

  8. Management • Steroids: Good for cerebral oedema secondary to tumours or abscesses - not trauma • Barbiturates: Thiopentone has been widely accepted as a means of treating raised intracranial pressure. However, it may also cause heamodynamic disturbances and mask the clinical effects of cerebral oedema. • Yasmin’s: Haemodynamic functions were monitored continuously.

  9. Management • Inter Cranial Pressure (ICP): Monitoring with extradural transducers may allow brainstem herniation to be anticipated and prevented. • This machine is a ICP monitor. • Most trusts now use ICP monitors these are usually placed into the right (non-dominant) frontal region through a small burr hole. It is calculated as mean arterial pressure minus intracranial pressure. Cerebral perfusion pressure is the principal determinant of cerebral blood flow.

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