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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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miércoles, 23 de diciembre de 2015

Meningitis severa

PulmCrit - December 21, 2015 by Josh Farkas

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  • "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."

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http://emcrit.org/pulmcrit/neurocritical-care-meningitis-icp