ICP– Lundberg Awaves

DianaJansen,ANIOSIC23-10-2015

Casus•Man,47jaar• D1statusnaHETmeternstigtraumatischschedel-hersenletselwvinbrengenICPmeter

• FrequenthogeICP’s maarooktussenpozenmetlageICP• Diepesedatie,thiopental enhypertoonzout,normothermie

ICP(1)Relationshipbetweenintracranialpressureandintracranialvolume

ICP(2)

P1=(Percussion wave)due tothearterial pulsation andreflects cerebral flowP2=(Tidal wave)due toretrogradevenous pulse ofthejugular against thecortical veins,represents intracranial complianceP3=(Dicrotic wave),represents aortic valve closure

Change inP2;predict failure cerebral autoregulationP2>P1indicates intracranial hypertension =noncompliant brain

Lundberg waves• 20%severe traumatichead injury

• Triggered by aprecipitating factor(e.g.hypotension,desaturation,highpCO2)à decrease CPP;leading toanintracerebral vasodilatory cascadeàincreased CBVà increase ICPinnon-compliant intracranial system(due toalready swollen brain)

• Autoregulation intactincombinationwith anon-compliant lowcompensatoryintracranial content

Lundberg Awaves =plateauwaves

Conclusie

• Kijkennaar• HoogteICP• Curve• Patronenteherkennen?

• Lundberg Awavespathologisch;tekenenvanzwellingbrein.Uitkomstnietperdefinitieslecht!