Raised Intracranial Pressure During CNS Infection

Tasker, Robert C.

doi:10.1097/ccm.0000000000000419

Cited by 6 publications

(3 citation statements)

References 19 publications

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“…Retrospective and prospective pediatric critical care studies conducted in India and their subsequent publication in regional and international journals have grown steadily in the past two decades ( 35 – 41 ). A handful of studies conducted by pediatric critical care researchers in India have impacted PICU care not only in the region but also outside the region—for example, original studies published from India on monitoring of intracranial and cerebral perfusion pressures in patients with acute meningoencephalitis have reinvigorated the field of neurocritical care ( 42 – 44 ). Recently, newer developments in collaborative, multicenter research initiatives in pediatric critical care have occurred in India.…”

Section: Introductionmentioning

confidence: 99%

Advances in Pediatric Critical Care Research in India

2018

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Over last 2 decades, there has been a significant progress made in the field of pediatric critical care in India. There has been complementary and parallel growth in the pediatric critical care services in India and the number of pediatric critical care providers who are either formally trained in India or who have returned to India after their formal training abroad. The pediatric critical care community in India has recognized obvious differences in profiles of critical illnesses and patients between Indian subcontinent and the West. Therefore there is a growing interest in generating scientific evidence through local research which would be applicable to critically ill children in Indian subcontinent. This article focuses on advances in pediatric critical care research in India and its future directions.

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Section: Introductionmentioning

confidence: 99%

Advances in Pediatric Critical Care Research in India

2018

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“…In turn, understanding the characteristics of pathogenetic disorders, both in the identified cohort of patients and in individuals, gives a reason to hope for the development of the doctrine of scientifically-based neurointensive therapy in non-surgical patients in spite of copying the protocols of intensive therapy for CCT, or, even worse, routine use of some aspects of intensive care (for example, using of osmodiuretics, or hyperventilation) without feedback about the feasibility and effectiveness of these prescriptions. As Robert C. Tasker, in a letter to Crit Care Med, says: "We need to review whether therapy to control ICP -mannitol and hyperventilationbenefits or potential harm (Tasker, 2014). In the Cochrane Review 2013, it was concluded that osmotic diuretics should not be prescribed to adult and pediatric patients with bacterial meningitis (Wall et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Non-invasive evaluation of cerebral hemodynamic and intracranial pressure in pediatric neuroinfections

Georgiynts

Корсунов

Ольховська

et al. 2018

Regul. Mech. Biosyst.

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The study of intracranial pressure (eICP), cerebral perfusion pressure (eCPP), cerebral blood flow index (CFI), zero flow pressure (ZFP) in 49 children hospitalized in the intensive care unit with severe course of neuroinfections was carried out. The level of consciousness was determined by the Glasgow pediatric scale. Monitoring of central and peripheral hemodynamics (ECG, heart rate, systolic, diastolic and mean blood pressure, and cardiac output), pulse oximetry, capnography, hemoglobin, hematocrit, total protein, urea, creatinine, lactate, glucose and serum electrolytes was done. An ultrasound scanner was used to perform ultrasound duplex scanning of blood flow in the left and middle cerebral artery (MCA), measuring maximum, minimum and average blood flow velocities, pulsation index (PI), and resistance index (RI). Based on the formulae of Edouard et al. indicators of eCPP, ZFP, CFI, eICP were calculated. The eSCP was also determined by the formulae of Kligenchöfer et al. and Bellner et al. All patients were divided into group I with RI > 1.3 and group II with RI < 1.3. It was found that eCPP in the group I was significantly less (29.5 ± 1.3 mm Hg) than in the II group (41.6 ± 1.7 mm Hg). Despite the lack of a reliable difference in blood pressure between groups I and II, the difference in eCPP was found due to a significant difference in eICP 34.6 ± 1.4 and 27.6 ± 0.89 mm Hg in I and II groups respectively. ZFP in group I was significantly higher than in group II. The indexes of the Glasgow coma scale was significantly lower in group I and 7.8 ± 0.6 points. There were observed direct moderate correlations between systolic blood pressure, cardiac output and eSRP and CFI, presumably associated with a loss of autoregulation. CFI in the group I was lower than in the group II. Thus, non-invasive examination of cerebral flow in MCA by duplex sonography revealed that PI > 1.3 is an informative marker of intracranial hypertension and reduction of cerebral perfusion, which is common in children with neuroinfections. To determine the eSRP and CFI it is advisable to use the formula of Edouard et al. and to determine the eICP the formula of Kligenchöfer et al. The obtained data can be useful for objectifying the severity of the condition, predicting the outcomes of neuroinfections, choosing the directions of intensive care and evaluating its effectiveness.

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“…However, invasive ICP measurement may not be available in certain situations, such as in underserved rural areas, in developing countries with limited resources or in settings outside the intensive care unit (ICU) and neurosurgical departments [4]. In several conditions, such as liver failure, preeclampsia, encephalitis, meningitis and stroke, the role of invasive ICP monitoring is not well established or the risk-benefit ratio remains unclear [5][6][7][8][9]. Moreover, invasive insertion of intracranial transducers can result in important complications, including infection and hemorrhage [10,11].…”

Section: Introductionmentioning

confidence: 99%