ブックタイトル第43回日本集中治療医学会学術集会プログラム・抄録集

概要

第43回日本集中治療医学会学術集会プログラム・抄録集

－185－SL13Neurosciences Critical Care Johns Hopkins University School of Medicine Baltimore, MD USARomergryko G. GeocadinSeveral important updates in the understanding and practice of neurocritical care have occurred in recent years. The goal ofneurocritical care is to minimize neurologic injury and improve outcomes. There are several approaches to achieve this in theICU. First is to limit primary injury to the brain. One key advance in limiting primary injury is to limit brain ischemia andrestore brain perfusion. Recently several studies showed the additional benefit of intra-arterial administration of tissueplasminogen activator（tPA）with IV-tPA for acute ischemic stroke. Crucial in management is patient selection as well asneurocritical care in the management of these patients.Another important goal in neurocritical care is to preventing secondary injury to the brain in patients who present with acuteetiologies. Some of the secondary injuries include increasing edema formation, expansion of the hematoma, increase inintracranial pressure（ICP）, and reduction in cerebral perfusion. Recently several studies focused on secondary injury will bereviewed: 1）the controversy of ICP monitoring in traumatic brain injury（TBI）, 2）therapeutic hypothermia to control ICP inacute TBI, 3）comparison of hypertonic saline to mannitol in treating cerebral edema and outcomes in patientswith severe TBI,and 4）use of prothrombin concentrate complex（PCC）to control hematoma expansion to improve outcomes in patientscerebral hemorrhage on anticoagulation therapy with warfarin.Lastly, the lecture will provide some updates on understand and management of coma and disorders of consciousness（DOC）.Coma and DOC in the ICU remain the strongest predictor of survival and quality of life of survivors, yet, we have limitedunderstanding of the brain structures that lead to coma and we have lesser understanding on how we can help patients recoverfrom coma or improve DOC. A recent study using neuro-imaging in patients with DOC for at least 4 weeks found areas of thebrain that accounts for DOC. In acute coma, it is known that a shift of the brain midline structures were associated with acuteDOC, but a recent study showed that reversal of midline shift was associated with awakening from coma. Several therapies,such as amantadine have been tried to improve DOC but recently transcranial direct current stimulation（tDCS）was shown toimprove patients in minimally conscious states.特別講演 13 2月14日（日）　9：50～10：50　第5会場Up-to-date of Neurocritical Care