Annales françaises d'anesthèsie et de rèanimation
-
Ann Fr Anesth Reanim · Jun 2012
Review[Near infrared spectroscopy monitoring in the neurointensive care].
Near infrared spectroscopy (NIRS) can noninvasively measure cerebral saturation in oxygen, that permits to estimate brain oxygenation and metabolism. This technique could be incorporated into a multimodal monitoring for severely brain-injured patients. This review presents the principles of NIRS, its limits, the main results from clinical studies and its perspectives. More clinical studies are needed before recommending the routine use of NIRS in the ICU.
-
The main purpose of neurointensive care is to fight against cerebral ischaemia. Ischaemia is the cell energy failure following inadequacy between supply of glucose and oxygen and demand. Ischemia monitoring starts with a global approach, especially with cerebral perfusion pressure (CPP) determined by mean arterial pressure and intracranial pressure (ICP). ⋯ PtiO(2)-guided management could lead to a continuous optimization of arterial oxygen transport for an optimal cerebral tissue oxygenation. Finally, PtiO(2) has probably a global prognostic value because studies showed that hypoxic values for a long period of time lead to an unfavourable neurologic outcome. In conclusion, PtiO(2) provides additional information for regional monitoring of cerebral ischaemia and deserves more intensive use to better understand it and probably improve neurointensive care management.
-
Ann Fr Anesth Reanim · Jun 2012
Review[Pituitary insufficiency after traumatic brain injury: consequences? Screening?].
Traumatic brain injury has been considered for long as a rare cause of hypopituitarism. Recent studies have already shown a prevalence of 30% of pituitary dysfunction following moderate or severe head injury that may persist into the chronic phase of recovery, hypogonadism and GH deficiency being the most common hormonal deficiencies. ⋯ However, there are limited data available regarding the impact of hypopituitarism, and the indications of hormonal replacement (especially GH replacement and hypogonadism treatment) still remain to be defined. The screening strategy for TBI - induced hypopituitarism has recently been revised.
-
Ann Fr Anesth Reanim · Jun 2012
Review[Non-invasive evaluation of intracranial pressure: how and for whom?].
The invasive monitoring of intracranial pressure is useful in circumstances associated with high-risk of raised intracranial pressure. However the placement of intracranial probe is not always possible and non-invasive assessment of intracranial pressure may be useful, particularly in case of emergencies. Transcranial Doppler measurements allow the estimation of perfusion pressure with the pulsatility index. Recently, new ultrasonographic methods of cerebral monitoring have been developed: the diameter of the optic nerve sheath diameter, a surrogate marker of raised intracranial pressure and the estimation of median shift line deviation.
-
Ann Fr Anesth Reanim · Jun 2012
Review[Water and electrolytes disorders after brain injury: mechanism and treatment].
Electrolyte disturbances are frequent after brain injuries, especially dysnatremia and dyskalemia. In neurological patients, usual clinical signs of hyponatremia are frequently confounded with clinical signs of the underlying disease. Natremia absolute value is less important than speed of onset of the trouble. ⋯ It is important to avoid excessively rapid correction of hypernatremia, with a maximal speed of correction of 0.5 m mol/l/h. Serum sodium monitoring should be mandatory for the first ten postoperative days after pituitary adenoma surgery. Therapeutic barbiturate may be responsible for life threatening dyskalemia.