뇌부종과 두개내압 상승의 기본치료원칙 = Basic principle in the management of brain edema and elevated intracranial pressure

다국어 초록 (Multilingual Abstract)

Background: Brain edema is a well-recognized pathophysiological secondary change after primary brain injury.
The mechanism of brain edema may differ based on the types of brain edema. However, numerous ion channels are involved in its development and are therefore currently a hot target for anti-edema therapy. Here, this paper reviews the clinically important differences among the types of brain edema and a step-wise management strategy for brain edema and elevated intracranial pressure (ICP).
Current Concepts: Brain edema can be classified as cytotoxic, ionic, vasogenic, and interstitial edema. Although the underlying mechanisms may differ among the various types of brain edema, multiple ion channels and the integrity of tight junctions are associated with the development of brain edema. If brain edema aggravates, the intracranial volume expands and leads to an elevation of ICP. A basic principle in the management of ICP includes proper positioning, screening for a need for extraventricular drainage, proper sedation, transient hyperventilation, assessing the intracranial water status with the serum sodium level, optimization of cerebral perfusion pressure, hyperosmolar therapy, targeted temperature management, and induction of a pharmacological coma with sedatives.
Discussion and Conclusion: Stepwise treatment strategies are recommended in the management of patients with ICP crisis. Based on the principle, detailed management plans need to be adjusted based on the status of an individual patient.

참고문헌 (Reference)

• 1 Yaltirik Bilgin E, "Vasogenic edema pattern in brain metastasis" 32 : 1020-1025, 2022
• 2 Tsuda K, "Transependymal edema as a predictor of endoscopic third ventriculostomy success in pediatric hydrocephalus" 156 : e215-, 2021
• 3 Andrews PJ, "Therapeutic hypothermia to reduce intracranial pressure after traumatic brain injury : the Eurotherm3235 RCT" 22 : 1-134, 2018
• 4 Ji C, "The role of glymphatic system in the cerebral edema formation after ischemic stroke" 340 : 113685-, 2021
• 5 Fried HI, "The insertion and management of external ventricular drains : an evidence-based consensus statement : a statement for healthcare professionals from the Neurocritical Care Society" 24 : 61-81, 2016
• 6 Simard JM, "Sulfonylurea receptor 1 in central nervous system injury : a focused review" 32 : 1699-1717, 2012
• 7 Sheth KN, "Safety and efficacy of intravenous glyburide on brain swelling after large hemispheric infarction(GAMES-RP) : a randomised, doubleblind, placebo-controlled phase 2 trial" 15 : 1160-1169, 2016
• 8 Jha RM, "Pathophysiology and treatment of cerebral edema in traumatic brain injury" 145 (145): 230-246, 2019
• 9 Benarroch EE, "Na+, K+-ATPase : functions in the nervoussystem and involvement in neurologic disease" 76 : 287-293, 2011
• 10 Ko SB, "Multimodality monitoring for cerebral perfusion pressure optimization in comatose patients with intracerebral hemorrhage" 42 : 3087-3092, 2011
• 11 Neff S, "Monro-Kellie doctrine" 85 : 1195-, 1996
• 12 Changa AR, "Management of elevated intracranial pressure : a review" 19 : 99-, 2019
• 13 Adrogué HJ, "Hyponatremia" 342 : 1581-1589, 2000
• 14 Cook AM, "Guidelines for the acute treatment of cerebral edema in neurocritical care patients" 32 : 647-666, 2020
• 15 Syková E, "Extracellular volume fraction and diffusion characteristics during progressive ischemia and terminal anoxia in the spinal cord of the rat" 14 : 301-311, 1994
• 16 Oertel M, "Efficacy of hyperventilation, blood pressure elevation, and metabolic suppression therapy in controlling intracranial pressure after head injury" 97 : 1045-1053, 2002
• 17 Mavrocordatos P, "Effects of neck position and head elevation on intracranial pressure in anaesthetized neurosurgical patients : preliminary results" 12 : 10-14, 2000
• 18 Liang D, "Cytotoxic edema : mechanisms of pathological cell swelling" 22 : E2-, 2007
• 19 Zeiler FA, "Burst suppression for ICP control" 32 : 130-139, 2017