Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Neuro ICU Monitoring

Neuro ICU Monitoring

Pdf Summary

The document outlines various aspects of neurointensive care and monitoring, focusing on primary and secondary brain injuries, intracranial pressure, status epilepticus, and stroke management.<br /><br />Primary brain injuries include trauma, hemorrhage, ischemia, tumor, and infection, while secondary injuries involve increased intracranial pressure (ICP), cerebral edema, hypoxia, hypercarbia, and electrolyte abnormalities. Understanding the Monroe-Kellie hypothesis is crucial for managing ICP.<br /><br />Status epilepticus, characterized by seizures lasting over 5 minutes, poses an increasing risk of neuronal damage and becomes harder to terminate pharmacologically the longer it lasts. Refractory status epilepticus (RSE), with persistent seizures despite treatment, carries high morbidity and mortality. Nonconvulsive status epilepticus (NCSE) is diagnosed via EEG and should be considered if a patient doesn't awaken within 30-60 minutes post-seizure.<br /><br />Effective management of strokes entails addressing the "five P's": parenchyma (limiting infarct size), pipes (improving flow), perfusion (avoiding hypotension and dehydration), penumbra (preserving vulnerable areas), and preventing complications like fever and deep vein thrombosis.<br /><br />Pediatric cerebrovascular conditions include arteriovenous malformations and intracranial aneurysms, which are rare but can lead to subarachnoid hemorrhage. Cerebral vein thrombosis and various forms of intracranial hemorrhage (epidural, subdural, subarachnoid, contusion) are critical considerations.<br /><br />Management of pediatric brain tumors involves addressing obstructive problems and peritumoral edema. Shunt issues in patients with shunts are critical to recognize promptly.<br /><br />Multidisciplinary neuro-resuscitation, continuous EEG assessment, and aggressive management of hypotension, hypoxia, and hypoglycemia are emphasized for improving outcomes in comatose patients.<br /><br />The document also touches on Posterior Reversible Encephalopathy Syndrome (PRES), characterized by headaches, visual complaints, and seizures, typically involving the parietal and occipital lobes, and highlighted through an MRI image.<br /><br />Key takeaway points include the importance of comprehensive neuro-resuscitation, continuous monitoring, and addressing systemic issues promptly for optimal management of critical CNS conditions.

Keywords

neurointensive care

intracranial pressure

primary brain injuries

secondary brain injuries

status epilepticus

stroke management

pediatric cerebrovascular conditions

brain tumors

Posterior Reversible Encephalopathy Syndrome

neuro-resuscitation

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