PulmCrit - December 21, 2015 by Josh Farkas
- "Severe meningitis is an emergency requiring neurocritical care, with careful attention to intracranial pressure (ICP) and cerebral perfusion pressure (CPP).
- The pressure transduced from a lumbar puncture is equal to the intracranial pressure. Measuring opening pressure allows for prompt identification of patients with elevated intracranial pressure.
- Drainage of CSF reduces the ICP. Because meningitis is a closed space infection, drainage might also speed resolution of the infection. This may be accomplished by a variety of methods (therapeutic lumbar puncture, indwelling lumbar drain, or external ventricular drain).
- The cerebral perfusion pressure (CPP = MAP – ICP) is the pressure gradient driving brain perfusion. The CPP should be supported aggressively, for example with norepinephrine.
- Because meningitis typically spares the brain tissue, these patients can experience dramatic improvement. However, this depends on rapid and meticulous care."
http://emcrit.org/pulmcrit/neurocritical-care-meningitis-icp
