Template:Increased ICP treatment

Increased ICP Treatment

1. Ensure adequate sedation (prevent gag reflex)
2. IVF to goal MAP >80 (maintains cerebral perfusion)
3. Mannitol
   • If SBP>90
     • If SBP>90 in adults use hypertonic saline NaCl 5% 150ml over 10 min
   • Reduces ICP w/in 30min; duration of action of 6-8hr
   • Bolus 20% @ 0.25-1 gm/kg as rapid infusion
   • Monitor I+O to maintain euvolemia
4. Hyperventilation
   • No longer recommended as prophylactic intervention
     • Hyperventilation to PaCO2 <25 never indicated
   • Brief course only recommended if impending herniation (i.e., Cushing reflex)
     • Maintain PaCO2 28-35 (20 breaths/min)
5. Seizure
   • Treat immediately
   • Seizure prophylaxis reduces seizures but does not improve long-term outcomes
6. Goal CPP ~60mmHg
   • If MAP <80, then CPP<60
     • consider crystalloids or colloids (plasma if INR>1.3)
     • phenylephrine 10-100mcg/min, or other pressors prn
     • transfuse PRBCs, Hb>7

• • RSI with possible lidocaine and fentanyl premedication
  • Elevate HOB 30 degrees (or reverse Trendelenburg position)
  • If continued signs of increasing ICP:
    • Mannitol 0.25 - 1 g/kg IV if MAP > 90 mmHg after NSGY c/s
    • Hyperventilation to 30-35 mmHg, no lower than 25 mmHg