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Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury and at rest, is normally 7–15 mmHg for a supine adult. This equals to 9–20 cmH 2 O, which is a common scale used in lumbar punctures. [1]
It can cause complications such as vision impairment due to intracranial pressure , permanent neurological problems, reversible neurological problems, seizures, stroke, and death. [1] However, aside from a few Level I trauma centers, ICP monitoring is rarely a part of the clinical management of patients with these conditions.
Intracranial pressure monitoring is just one tool to manage ICP. It is used in conjunction with other techniques such as ventilator settings to manage levels of carbon dioxide in the blood, head and neck position, and other therapies such as hyperosmolar therapy, medications, and core temperature. [2]
Cerebral perfusion pressure (CPP) is defined as the mean arterial pressure (MAP) minus the intracranial pressure (ICP). In normal individuals, it should be above 50 mm Hg. Intracranial pressure should not be above 15 mm Hg (ICP of 20 mm Hg is considered as intracranial hypertension). [14]
Cushing reflex (also referred to as the vasopressor response, the Cushing effect, the Cushing reaction, the Cushing phenomenon, the Cushing response, or Cushing's Law) is a physiological nervous system response to increased intracranial pressure (ICP) that results in Cushing's triad of increased blood pressure, irregular breathing, and bradycardia. [1]
An alternative definition of CPP is: [1] = where: MAP is mean arterial pressure ICP is intracranial pressure JVP is jugular venous pressure. This definition may be more appropriate if considering the circulatory system in the brain as a Starling resistor, where an external pressure (in this case, the intracranial pressure) causes decreased blood flow through the vessels.
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