Critical Care Neurology

This chapter presents a discussion on critical care neurology. Respiratory disorders in neurological patients usually do not occur from primary lung disease. Basically, neurological respiratory disorders can be subdivided into three different origins-disturbances in breathing mechanics, protecting reflexes and central respiratory drive; physiological and psychological stress, requiring artificial ventilation; and when sedation is necessary. In many neurological disorders the patients are awake while experiencing the respiratory distress. In neuromuscular disease a disturbance of breathing mechanics together with an absence of gag reflexes is an indication for intubation. Although respiratory problems are rare in the first few hours after an acute stroke, pulmonary complications constitute a major cause of morbidity and mortality in intensive care unit (ICU) patients with cerebrovascular disease. The maintenance of adequate ventilation and oxygenation is an important prerequisite for the preservation of metabolic turnover in the marginal zone of an ischemic stroke, the so-called penumbra. Respiratory dysfunction may develop as the result of a reduction in alveolar gas exchange caused by atelectasis or pneumonia in immobilized patients, hypoventilation caused by impaired central respiratory drive or critical care neuropathy, or upper airway obstruction caused by oropharyngeal muscular dysfunction. The chapter discusses fluids and nutrition, central venous catheter, sedation, osmotherapy, malignant hyperthermia (MH), and others.