神経集中治療—頭蓋内圧亢進と脳ヘルニアへの対処

Neurointensive Care:Managing Intracranial Hypertension and Cerebral Herniation

Point

・頭蓋内圧管理はmultimodality monitoringと（病態）生理学の知識が必要である．

・Stepwise protocolを用いて頭蓋内圧管理を行う．

・二次性脳損傷を防ぐことが重要である．

　In order to optimize neurological outcomes in patients presenting with elevated intracranial pressure, secondary cerebral insults during therapeutic interventions should be prevented and mitigated. Considering the absence of a singular, definitive monitoring parameter, the diverse facets of its pathophysiology—encompassing the Monroe-Kellie doctrine, brain compliance, and cerebral metabolism—should be understood. Multimodality monitoring, which incorporates physiological indicators of intracranial pressure sensors, electroencephalograms, and ultrasound, can be assessed in an integrative manner. These assessments subsequently inform surgical and intensive care strategies, often guided by structured protocols, such as a stepwise approach. This comprehensive paradigm, central to neurocritical care, may significantly enhance the neurological prognosis of patients.