Template:Increased ICP treatment
Revision as of 07:01, 6 June 2015 by Rossdonaldson1 (talk | contribs)
Increased ICP Treatment
- Ensure adequate sedation (prevent gag reflex)
- IVF to goal MAP >80 (maintains cerebral perfusion)
- 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
- If SBP>90
- 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)
- No longer recommended as prophylactic intervention
- Seizure
- Treat immediately
- Seizure prophylaxis reduces seizures but does not improve long-term outcomes
- 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
- If MAP <80, then CPP<60