Management of Intracranial Pressure.
Abstract | PURPOSE OF REVIEW: RECENT FINDINGS: ICP must be measured through an invasive brain catheter, typically an external ventricular catheter that can drain CSF and measure ICP, or through an intraparenchymal ICP probe. Proper recognition of the clinical signs of elevated ICP is essential for timely diagnosis and treatment to prevent cerebral hypoperfusion and possible brain death. Clinical signs of elevated ICP include headache, papilledema, nausea, and vomiting in the early phases, followed by stupor and coma, pupillary changes, hemiparesis or quadriparesis, posturing and respiratory abnormalities, and eventually cardiopulmonary arrest. SUMMARY: Management of elevated ICP is, in part, dependent on the underlying cause. Medical options for treating elevated ICP include head of bed elevation, IV mannitol, hypertonic saline, transient hyperventilation, barbiturates, and, if ICP remains refractory, sedation, endotracheal intubation, mechanical ventilation, and neuromuscular paralysis. Surgical options include CSF drainage if hydrocephalus is present and decompression of a surgical lesion, such as an intracranial hematoma/large infarct or tumor, if the patient's condition is deemed salvageable. Future research should continue investigating medical and surgical options for the treatment of raised ICP, such as hypothermia, drugs that reduce cerebral edema, and operations aimed at reducing intracranial mass effect.
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Authors | W David Freeman |
Journal | Continuum (Minneapolis, Minn.)
(Continuum (Minneap Minn))
Vol. 21
Issue 5 Neurocritical Care
Pg. 1299-323
(Oct 2015)
ISSN: 1538-6899 [Electronic] United States |
PMID | 26426232
(Publication Type: Journal Article, Review)
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Topics |
- Critical Care
(methods)
- Disease Management
- Humans
- Intracranial Hypertension
(diagnosis, therapy)
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