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Neurological assessment of the acute cardiac care patient 

Neurological assessment of the acute cardiac care patient
Chapter:
Neurological assessment of the acute cardiac care patient
Author(s):

Cathy De Deyne

, Ward Eertmans

, and Jo Dens

DOI:
10.1093/med/9780199687039.003.0016_update_001

Update:

In the first part, concerning all possible cerebral monitoring techniques in ICCU patients, we did add some more “clarifications” as to “cerebral perfusion pressure” in the absence of invasive intracranial pressure monitoring, which is the case in most of the ICCU patients … therefore, we wanted to add some more “clarifications” on “how to apply cerebral perfusion pressure” in the absence of invasive intracranial pressure.

Concerning the use of Near Infrared Spectroscopy, we did add some “newly” published information concerning as well technology as clinical application of this monitoring technique in ICCU patients.

Finally, in the second part, on the use of cerebral monitoring for prognostication after cardiac arrest, we did add/change the content of our previous text, in order to follow the newest guidelines (published by many international authorities) from 2015 on, to propose a text completely in accordance with these newest guidelines.

Updated on 22 February 2018. The previous version of this content can be found here.
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date: 23 October 2019

Many techniques are currently available for cerebral physiological monitoring in the intensive cardiac care unit environment. The ultimate goal of cerebral monitoring applied during the acute care of any patient with/or at risk of a neurological insult is the early detection of regional or global hypoxic/ischaemic cerebral insults. In the most ideal situation, cerebral monitoring should enable the detection of any deterioration before irreversible brain damage occurs or should at least enable the preservation of current brain function (such as in comatose patients after cardiac arrest). Most of the information that affects bedside care of patients with acute neurologic disturbances is now derived from clinical examination and from knowledge of the pathophysiological changes in cerebral perfusion, cerebral oxygenation, and cerebral function. Online monitoring of these changes can be realized by many non-invasive techniques, without neglecting clinical examination and basic physiological variables—with possible impact on optimal cerebral perfusion/oxygenation—such as invasive arterial blood pressure monitoring or arterial blood gas analysis.

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