Increased intracranial pressure

Clinical Manifestations

Invasive monitoring of ICP
- Indications
  - At risk for elevated ICP
  - Comatose
  - Prognosis not hopeless
- Contraindications
  - Bleeding diathesis or anticoagulation
- Risks
  - Intracranial hemorrhage (1-2%)
- Devices
  - Intraventricular catheters
  - Parenchymal monitors
  - Extra-axial devices
  - Non-invasic TCD of JvO2
- Aim for ICP < 20 while maintaining cerebral perfusion pressure > 70
  - Based on extra-auditory meatus
Decrease intracerebral contents
- Vascular
  - Elevate head of bed
  - Hyperventilation to pCO2 30-40 (though can go lower acutely)
- CSF
  - Reduce CSF production with furosemide or acetazolamide
  - CSF drainage
- Parenchyma
  - Remove the mass or create space
  - Osmotic diuresis with mannitol and 3% saline
- Brain volume
  - Hypertonic saline 3% 5ml/kg
  - Mannitol 1g/kg
Increase skull capacity
- Craniectomy or decompression
Decrease oxygen demand
- Deep sedation with propofol or barbiturates
- Hypothermia
- Paralysis (decreases systemic demand meaning more oxygen available to the brain)