Template:Increased ICP treatment: Difference between revisions

Revision as of 20:06, 11 June 2015

Elevate HOB 30 degrees (or reverse Trendelenburg position)
IVF to goal MAP >80 (maintains cerebral perfusion)
Mannitol
- If SBP>90
- 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
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)
Seizure
- Treat immediately
- Seizure prophylaxis reduces seizures but does not improve long-term outcomes
If need for RSI, consider pretreatment with lidocaine and/or fentanyl
- Also ensure adequate sedation (prevent gag reflex)
Goal cerebral perfusion pressure (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

@@ Line 4: / Line 4: @@
 #[[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