REVIEW – November 2008

Principles of intensive care in patients with severe brain damage


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Outcome of patients with severe brain damage (brain injury, stroke, meningitis-encephalitis, epileptic status, various-cause respiratory insufficiency has significantly improved after the establishment of specific neuro-intensive care units for these patients.
The extent of brain damage is determined not only by initial causative factors: the pathophysiological and metabolic changes caused by initial factors may lead to further brain damage. Therefore, in addition to treatment of causative pathology (removal of intracranial haematoma or tumour, closure of vascular aneurysm, use of anti-inflammatory drugs, etc.) options of modern intensive care can prevent and correct accompanying brain damage.
Application of continuous monitoring of neurological status, intracranial pressure, EEG, transcranial Doppler sonography and methods of brain imaging permit early detection of intracranial haematomas and ischaemic complications.
Monitoring of blood oxygen level, acid-base balance, haemodynamic changes, electrolytes and glycose metabolism helps detect and correct hazardous metabolic disturbances accompanying brain damage.
The most important measures for improving the outcome of severe brain injury are adequate control of ventilation and haemodynamic parameters from the onset of ictus – both prior to hospitalization and at every stage medical aid.