Modulação da pressão intracraniana em um modelo experimental de hipertensão abdominal e lesão pulmonar aguda

Zampieri, Fernando G.; Almeida, J; Schettino, Guilherme; Park, Marcelo; Machado, Fábio Prates; Azevedo, Luciano César Pontes

doi:10.1590/s0103-507x2011000200008

Cited by 5 publications

(2 citation statements)

References 17 publications

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“…Elevation of venous pressure in LPA situations may also correlate with the elevation of ICP, probably by reducing the pressure gradient for cerebral venous drainage. 28 Characteristics such as subarachnoid hemorrhages and cerebral herniation should also be monitored since they are part of the group of complications due to ICP. 29 Diffuse or localized increase in brain volume tends to displace some part of the encephalon in relation to the intracranial compartments of the dural folds.…”

Section: Nursing Care Justificationmentioning

confidence: 99%

Service of nursing in intracranial pressure monitoring in patients neurocríticos / Assistência de enfermagem na monitorização da pressão intracraniana em pacientes neurocríticos

Ribeiro

Lima²,

Gonçalves

et al. 2019

R. pesq. cuid. fundam. online

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Objetivo: Identificar por meio da literatura as intervenções de enfermagem na monitorização da pressão intracraniana em pacientes neurocríticos. Método: Revisão integrativa da literatura com busca dos artigos nas bases de dados SciELO, LILACS e PUBMED. Os artigos selecionados foram publicados entre os anos de 2007 e 2017. Resultados: Foram encontrados 94 artigos e excluídos 78 conforme critérios de inclusão. Assim 16 artigos foram usados nesta revisão. Estes apontaram que a monitorização neurológica pode ser realizada de maneira invasiva e não invasiva. Entre os métodos invasivos está a monitorização da pressão intracraniana, sendo o enfermeiro, responsável direto neste cuidado. Assim, cuidados como a elevação da cabeceira, cuidados com aspiração traqueal, cuidados com hipoxemia, coordenação e gerenciamento no cuidados de enfermagem dentre outros devem fazer parte da assistência de enfermagem. Conclusão: Os cuidados de enfermagem são indispensáveis para o paciente neurocrítico. Estes cuidados contribuem tanto para evolução positiva quanto negativa desses pacientes.

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Section: Nursing Care Justificationmentioning

confidence: 99%

Service of nursing in intracranial pressure monitoring in patients neurocríticos / Assistência de enfermagem na monitorização da pressão intracraniana em pacientes neurocríticos

Ribeiro

Lima²,

Gonçalves

et al. 2019

R. pesq. cuid. fundam. online

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“…The applicability of these findings is immediate. (7) The authors found that plateau (P plateau ), Peak (P peak ) and Pleural (P pl ) pressures were significantly increased with IAH and acute lung injury (ALI), without significant hemodynamic changes. With respect to the association of IAH, ALI and 27 cmH 2 O PEEP, significant hemodynamic…”

mentioning

confidence: 99%

Hipertensão intra-abdominal associada à lesão pulmonar aguda: efeitos sobre a pressão intracraniana

Falcão¹,

Oliveira²

2011

Rev. bras. ter. intensiva

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Hipertensão intra-abdominal associada à lesão pulmonar aguda: efeitos sobre a pressão intracraniana EDITORIAL Intra-abdominal hypertension (IAH) is defined as intra-abdominal pressure (IAP) above 12 mmHg and may be categorized as Grade I (12-15 mmHg), Grade II (16-20 mmHg), Grade III (21-25 mmHg) or Grade IV (> 25 mmHg). Recurrent or persistent IAP above 20 mmHg, in association with failure of at least one organ, is called Abdominal Compartment Syndrome (ACS). The mortality and morbidity of IAH and ACS are high and may reach 100% for unattended ACS. Deleterious effects of increased intra-abdominal pressure are not limited to the abdomen but finally impact the pressure balances on other organ systems such as the respiratory, cardiovascular and cerebral systems. (1)(2) On the chest, IAH displaces the diaphragm cranially, thereby reducing the intra-thoracic volume and increasing the intra-thoracic pressure (ITP); this reduces the compliance of the chest wall, lung and heart cavities, resulting in both respiratory and cardiovascular effects. (3)(4) Considering the head, IAH increases the intracranial pressure (ICP) and reduces the cerebral perfusion pressure (CPP). (3) Increased ICP is ascribed to the increased central venous pressure (CVP), reduced brain venous flow and reduced lumbar venous plexus flow, with concomitant imbalance of the intracranial contents, as proposed by Monroe-Kellie. (3)(4)(5) The mechanic effects of inferior vena cava compression during IAH reduces lumbar venous plexus flow and may also be responsible for the increased ICP. (5) Not only IAH, but also the increase in ITP due to mechanical ventilation, may determine ICP changes. The use of high inspiratory pressure and positive end-expiratory pressure (PEEP), which results in increased airway pressures, can lead to increased ITP and consequently, to increased central venous pressure, resulting in increased ICP. However, the effects of positive pressure ventilation on ICP are apparently influenced by several factors, including pulmonary and cerebral compliance. (6) In the study entitled "Modulation of intracranial pressure in an experimental model of abdominal hypertension and acute lung injury," the authors evaluated the association between IAH and pulmonary injury on the ICP. According to their results, this interaction impacted the ICP more significantly than IAH alone. The applicability of these findings is immediate. (7) The authors found that plateau (P plateau ), Peak (P peak ) and Pleural (P pl ) pressures were significantly increased with IAH and acute lung injury (ALI), without significant hemodynamic changes. With respect to the association of IAH, ALI and 27 cmH 2 O PEEP, significant hemodynamic

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Pathophysiology of Brain Injury and Neurological Outcome in Acute Respiratory Distress Syndrome: A Scoping Review of Preclinical to Clinical Studies

et al. 2021

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Acute respiratory distress syndrome (ARDS) has been associated with secondary acute brain injury (ABI). However, there is sparse literature on the mechanism of lung-mediated brain injury and prevalence of ARDS-associated secondary ABI. We aimed to review and elucidate potential mechanisms of ARDS-mediated ABI from preclinical models and assess the prevalence of ABI and neurological outcome in ARDS with clinical studies. We conducted a systematic search of PubMed and five other databases reporting ABI and ARDS through July 6, 2020 and included studies with ABI and neurological outcome occurring after ARDS. We found 38 studies (10 preclinical studies with 143 animals; 28 clinical studies with 1175 patients) encompassing 9 animal studies (n = 143), 1 in vitro study, 12 studies on neurocognitive outcomes (n = 797), 2 clinical observational studies (n = 126), 1 neuroimaging study (n = 15), and 13 clinical case series/reports (n = 15). Six ARDS animal studies demonstrated evidence of neuroinflammation and neuronal damage within the hippocampus. Five animal studies demonstrated altered cerebral blood flow and increased intracranial pressure with the use of lung-protective mechanical ventilation. High frequency of ARDS-associated secondary ABI or poor neurological outcome was observed ranging 82-86% in clinical observational studies. Of the clinically reported ABIs (median age 49 years, 46% men), the most common injury was hemorrhagic stroke (25%), followed by hypoxic ischemic brain injury (22%), diffuse cerebral edema (11%), and ischemic stroke (8%). Cognitive impairment in patients with ARDS (n = 797) was observed in 87% (range 73-100%) at discharge, 36% (range 32-37%) at 6 months, and 30% (range 25-45%) at 1 year. Mechanisms of ARDS-associated secondary ABI include primary hypoxic ischemic injury from hypoxic respiratory failure, secondary injury, such as lung injury induced neuroinflammation, and increased intracranial pressure from ARDS lung-protective mechanical ventilation strategy. In summary, paucity of clinical data exists on the prevalence of ABI in patients with ARDS. Hemorrhagic stroke and hypoxic ischemic brain injury were commonly observed. Persistent cognitive impairment was highly prevalent in patients with ARDS.

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Modulação da pressão intracraniana em um modelo experimental de hipertensão abdominal e lesão pulmonar aguda

Cited by 5 publications

References 17 publications

Service of nursing in intracranial pressure monitoring in patients neurocríticos / Assistência de enfermagem na monitorização da pressão intracraniana em pacientes neurocríticos

Service of nursing in intracranial pressure monitoring in patients neurocríticos / Assistência de enfermagem na monitorização da pressão intracraniana em pacientes neurocríticos

Hipertensão intra-abdominal associada à lesão pulmonar aguda: efeitos sobre a pressão intracraniana

Pathophysiology of Brain Injury and Neurological Outcome in Acute Respiratory Distress Syndrome: A Scoping Review of Preclinical to Clinical Studies

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