Zusammenfassung
Bei primären und sekundären Hirnerkrankungen kann es durch intrakranielle Volumenzunahmen in den drei Kompartimenten Hirngewebe, Liquor oder Blut zu kritischen Anstiegen des Hirndrucks (ICP) kommen. Ein steigender Hirndruck führt zu typischen klinischen Symptomen, kann aber bei analgosedierten Patienten nur durch eine invasive Hirndruckmessung erkannt werden. Andere Neuromonitoring-Verfahren haben nicht den Stellenwert der ICP-Messung erreicht, sie spiegeln die ICP-Veränderungen und deren Folgen durch andere metabolische und Oxygenierungsparameter wider. Der für die Hirndurchblutung relevante zerebrale Perfusionsdruck (CPP) errechnet sich aus der Differenz zwischen dem systemischen mittleren arteriellen Druck (MAP) und dem ICP. Für die unterschiedlichen hirndrucksenkenden Therapiemaßnahmen wie Hyperventilation, hyperosmolare Substanzen, Hypothermie, Glukokortikosteroide, Liquordrainagen und Dekompressionen bestehen für die einzelnen Erkrankungen heterogene Evidenzen.
Abstract
In primary and secondary brain diseases, increasing volumes of the three compartments of brain tissue, cerebrospinal fluid, or blood lead to a critical increase in intracranial pressure (ICP). A rising ICP is associated with typical clinical symptoms; however, during analgosedation it can only be detected by invasive ICP monitoring. Other neuromonitoring procedures are not as effective as ICP monitoring; they reflect the ICP changes and their complications by other metabolic and oxygenation parameters. The most relevant parameter for brain perfusion is cerebral perfusion pressure (CPP), which is calculated as the difference between the middle arterial pressure (MAP) and the ICP. A mixed body of evidence exists for the different ICP-reducing treatment measures, such as hyperventilation, hyperosmolar substances, hypothermia, glucocorticosteroids, CSF drainage, and decompressive surgery.
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Dietrich, W., Erbguth, F. Hirndruck und Hirnödem. Anaesthesist 62, 757–772 (2013). https://doi.org/10.1007/s00101-013-2236-0
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DOI: https://doi.org/10.1007/s00101-013-2236-0