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Monitoring des Hirndrucks

Indikation, Limitierungen, Praxis

Monitoring intracranial pressure

Indication, limits, practice

  • Medizin aktuell
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Zusammenfassung

Die Funktion des Organs Gehirn ist beim komatösen oder sedierten Patienten nicht sicher überprüfbar. Da der sekundäre Hirnschaden die Gefahr des Hirnödems beinhaltet, ist es notwendig, die resultierenden Drucksteigerungen zu erkennen. Deshalb ist die Messung des intrakraniellen Drucks („intracranial pressure“, ICP) das Standard-Monitoring-Verfahren in der Neurointensivmedizin. Das Verfahren, über eine Bohrlochtrepanation einen kleinen Drucksensor auf oder im Hirn zu platzieren, ist komplikationsarm und erlaubt eine technisch verlässliche Überwachung. Andere Neuromonitoring-Verfahren haben nicht den Stellenwert der ICP-Messung erreicht, sie spiegeln nur die ICP-Veränderungen mit anderen Messprinzipien wider. Die ICP-Messung ist das Verfahren, das über die konservativen Maßnahmen auf der Intensivstation zur Sicherstellung der zerebralen Perfusion oder die Indikation zum chirurgischen Eingriff entscheidet. „Central venous pressure“ (CVP), „intra-abdominal pressure“ (IAP) und „positive end-expiratory pressure“ (PEEP) haben keinen wesentlichen Einfluss auf den ICP.

Abstract

The function of the brain is not checkable in comatose or sedated patients. Because secondary brain damage will often cause brain edema it is necessary to recognize the resulting increases in brain pressure. Therefore, measurement of intracranial brain pressure (ICP) is the standard monitoring procedure in neurological intensive care. The procedure with a small drill hole trepanation and the insertion of a micropressure sensor has a comparatively low complication rate and offers continuous monitoring with reliable values. Other neuro-monitoring procedures have not achieved the value of ICP measurement and only reflect changes in ICP with other measurement principles. ICP measurement is the procedure which is decisive for conservative measures in the intensive care unit to secure cerebral perfusion or indications for surgical treatment of brain edema. Central venous pressure, intra-abdominal pressure and positive end-expiratory pressure do not have a substantial influence on ICP.

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  1. Allgemeines Krankenhaus Celle, Siemensplatz, 29223, Celle, Deutschland

    E. Rickels

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Rickels, E. Monitoring des Hirndrucks. Anaesthesist 58, 398–404 (2009). https://doi.org/10.1007/s00101-009-1523-2

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