The Indian Journal of Pediatrics

, Volume 76, Issue 5, pp 519–529

Management of intracranial hypertension

Symposium on Neurological Disorder-Advances in Management-II

DOI: 10.1007/s12098-009-0137-7

Cite this article as:
Singhi, S.C. & Tiwari, L. Indian J Pediatr (2009) 76: 519. doi:10.1007/s12098-009-0137-7


Raised intracranial pressure (ICP) is a life threatening condition that is common to many neurological and non-neurological illnesses. Unless recognized and treated early it may cause secondary brain injury due to reduced cerebral perfusion pressure (CPP), and progress to brain herniation and death. Management of raised ICP includes care of airway, ventilation and oxygenation, adequate sedation and analgesia, neutral neck position, head end elevation by 20°–30°, and short-term hyperventilation (to achieve PCO2 32–35 mm Hg) and hyperosmolar therapy (mannitol or hypertonic saline) in critically raised ICP. Barbiturate coma, moderate hypothermia and surgical decompression may be helpful in refractory cases. Therapies aimed directly at keeping ICP <20 mmHg have resulted in improved survival and neurological outcome. Emerging evidence suggests that cerebral perfusion pressure targeted therapy may offer better outcome than ICP targeted therapies.

Key words

Intracranial pressure Children Traumatic brain injury Cerebral perfusion pressure Hyperosmolar therapy 

Copyright information

© Dr. K C Chaudhuri Foundation 2009

Authors and Affiliations

  1. 1.Pediatric Emergency and Intensive Care Units, Department of Pediatrics, Advanced Pediatrics CentrePost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  2. 2.Department of PediatricsAdvanced Pediatric CentreChandigarhIndia

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