@HopkinsNCCU
@PulmCrit
@drdangayach
@neurochristiana
@nirmalregency
@interneurona
@MicieliA_MD
@mettermd
@oneDRwoman_
@OGdukeneurosurg
@AvrahamCooperMD

@a_charidimou
@EricLawson90
@CajalButterfly
@Capt_Ammonia
@DrAtulRamesh1
@RamaniBalu1
@DSandsmarkMDPhD
@PennNeurology
@TJUHNeuroCrit
@namorrismd
@ShadiYaghi2
@MDNeurocritcare

End/ What are your thoughts on this #neurocritcare? Where do you measure ICP and MAP? Should this be standardized across the board?

@neurocritcarej
@swarnarmd
@aartisarwal
@alyssafloseldes
@caseyalbin
@JimmySuhMD
@JimSiegler
@medinariojaMD

12/ So as you can 👀 a seemingly 🤏 change in the way 1 center 📏 ICP and MAP had a pretty huge effect on 💊 for its patients! This is quite remarkable & it makes you wonder how wide of an implication it could have in terms of outcome and mortality

11/ As a result:
👉 Clonidine and metoprolol use ⬇️
👉 Norepinephrine use ⬆️

10/ As expected, they found:
✅ ICP ⬆️ when measured at ear
✅ CPP ⬇️ when measured at ear
✅ MAP did not differ between groups

9/ In this retrospective review of #TBI patients, they compared 49 patients from the 2013-16 vs. 53 in the 2018-22 time period and were well matched:

8/ In this 🇸🇪 study, a unique opportunity presented itself when the department changed where it measures ICP and MAP (after a review of the literature) as detailed in the diagram below:

7/ As you can imagine, depending on where you measure your MAP, your CPP values will be very different (image from: link.springer.com/ar...)

6/ You measure MAP at the level of:
a. Heart (right atrium)
b. Tragus
c. Outer canthus
d. Other

5/ Now, let’s talk about where you measure ICP and MAP:

You measure ICP at the level of:
a. Tragus
b. Outer Canthus
c. Nasion
d. Foramen of Monro

4/ Now you all remember:

CPP = MAP – ICP

When we do not have an appropriate monitor to assess #CBF (cerebral blood flow), we use perfusion pressure as a surrogate

3/ Much of the #ICP data comes from such patients, and much of what we do in #neurocritcare is still to do our best to maintain normal parameters, such as:
👉 ICP <22
👉 CPP >60
(For more see link.springer.com/ar...)

2/ When we think about #ICP monitoring, a lot of the parameters that we use come from research where it was shown that ICP>20 was related to ⬆️ ☠️ in #TBI 🤕 patients