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2 - Intracranial Pressure Monitoring and Management

Published online by Cambridge University Press:  19 May 2022

By
Tanuwong Viarasilpa ,
Charles L Francoeur  and
Stephan A Mayer
Edited by
Andrew M. Naidech
Andrew M. Naidech
Affiliation:
Northwestern University, Illinois
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Summary

Intracranial hypertension is a life-threatening condition that if left unchecked can lead to brain herniation, cerebral ischemia, and brain death. Intracranial pressure (ICP) monitoring is frequently helpful for patient management. If placed, the monitor should be inserted in comatose patients at high risk for elevated ICP. ICP values, trends, and waveforms should be analyzed in conjunction with cerebral perfusion pressure (CPP) to guide therapy. Patients with elevated ICP can be managed using a tiered strategy that emphasizes cerebral spinal fluid drainage, sedation, and CPP optimization (tier one) prior to initiating bolus osmotherapy, hyperventilation, or paralysis (tier two). Multimodality monitoring therapy is a promising strategy that can detect secondary brain injury early and allow individualized treatment. Tier-three strategies for superrefractory ICP elevation include decompressive craniectomy, hypothermia, and pentobarbital infusion. Of these, craniectomy appears to be the most effective measure for reducing mortality, especially in younger patients.

Type
Chapter
Information
Neurocritical Care , pp. 6 - 31
Publisher: Cambridge University Press
Print publication year: 2022

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