Critical care nursing quarterly
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Traumatic brain injury (TBI) is defined as "a blow or jolt to the head ...which can disrupt the function of the brain" (CDC. Traumatic brain injury [TBI]: Topic Home. 2004 [http://www.cdc.gov]). ⋯ The critical care clinician who is able to identify and treat appropriately utilizing best practice guidelines may significantly reduce the morbidity and mortality of TBI. This article describes the classification, mechanism of injury, pathophysiology, and clinical therapeutic management strategies identified as best practice for TBI.
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During the past decade, brain tissue oxygen monitoring has been studied predominantly in Europe. Cerebral oxygenation monitoring was implemented in many intensive care units and correlations of intracranial pressure, cerebral perfusion pressure, end-tidal carbon dioxide monitoring, fever and partial pressure of brain tissue oxygenation (Pbto2) have been described (Crit Care Nurse. 2003;23[4, pt 1]:17-27). ⋯ This article will discuss the history of treatment of traumatic brain injury and how treatment interventions are changing with the latest technological advances in monitoring of cerebral oxygen levels and suggested interventions and factors that affect brain tissue oxygenation. It is clear that by understanding the causes of hypoxia and ischemia--along with the interventions to treat them--the critical care team will be better able to prevent low oxygen states in the brain and optimize treatment, thus improving patient outcome.
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Cerebral vasospasm is a significant problem after subarachnoid hemorrhage, with often devastating consequences. Its pathogenesis remains poorly understood despite extensive research. ⋯ Caring for patients after subarachnoid hemorrhage requires awareness of the potential for the development of vasospasm, and knowledge of the steps necessary to ensure its timely diagnosis and treatment. This article will review the current body of knowledge as it pertains to vasospasm and outline the direction of ongoing research.