Intracranial Pressure Management

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Abstract

A key aspect in neurocritical care is attention to and management of intracranial hypertension or elevated intracranial pressure (ICP). The skull is a closed, non-compressible vault, and a constant equilibrium must be maintained between the brain tissue, cerebrospinal fluid (CSF) and blood within. When a critical volume change has occurred and compensation is lost, an elevated ICP may result. Several interventions can effectively manage elevated ICP.

Keywords

Intracranial hypertension ICP Cerebral edema Osmotherapy Herniation 
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References

  1. 1.
    Josephson L. Management of increased intracranial pressure. Dim Crit Care Nurs. 2004;23(5):194–207.CrossRefGoogle Scholar
  2. 2.
    Eigsti J, Henke K. Anatomy and physiology of neurological compensatory mechanisms. Dim Crit Care Nur. 2000;25(5):197–202.CrossRefGoogle Scholar
  3. 3.
    Zoerle T, Lombardo A, Colombo A, et al. Intracranial pressure after subarachnoid hemorrhage*. Crit Care Med. 2015;43(1):168–76. doi: 10.1097/ccm.0000000000000670.CrossRefPubMedGoogle Scholar
  4. 4.
    Stevens R, Shoykhet M, Cadena R. Emergency neurological life support: intracranial hypertension and herniation. ENLS Version 20. 2015;23:76–82.Google Scholar
  5. 5.
    Hickey J. The clinical practice of neurological and neurosurgical nursing. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2003.Google Scholar
  6. 6.
    Skoglund K, Enblad P, Marklund N. Monitoring and sedation differences in the management of severe head injury and subarachnoid hemorrhage among neurocritical care centers. J Neurosci Nurs. 2013;45(6):360–8. doi: 10.1097/jnn.0b013e3182a3cf4f.CrossRefPubMedGoogle Scholar
  7. 7.
    Changoor NR, Haider AH. Pharmacological and surgical treatment of intracranial hypertension. Current Trauma Reports. 2015;1(3):155–9. doi: 10.1007/s40719-015-0021-z.CrossRefGoogle Scholar
  8. 8.
    Colton K, Yang S, Hu PF, et al. Intracranial pressure response after pharmacologic treatment of intracranial hypertension. J Trauma Acute Care Surg. 2014;77(1):47–53. doi: 10.1097/ta.0000000000000270.CrossRefPubMedGoogle Scholar
  9. 9.
    Lazaridis C, Neyens R, Bodle J, DeSantis SM. High-osmolarity saline in neurocritical care. Crit Care Med. 2013;41(5):1353–60. doi: 10.1097/ccm.0b013e31827ca4b3.CrossRefPubMedGoogle Scholar
  10. 10.
    Vialet R, Albanèse J, Thomachot L, et al. Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2 mL/kg 7.5% saline is more effective than 2 mL/kg 20% mannitol. Crit Care Med. 2003;31(6):1683–7. doi: 10.1097/01.ccm.0000063268.91710.df.CrossRefPubMedGoogle Scholar
  11. 11.
    Mangat HS, Chiu Y-L, Gerber LM, Alimi M, Ghajar J, Härtl R. Hypertonic saline reduces cumulative and daily intracranial pressure burdens after severe traumatic brain injury. J Neurosurg. 2015;122(1):202–10. doi: 10.3171/2014.10.jns132545.CrossRefPubMedGoogle Scholar
  12. 12.
    Li M, Chen T, Chen S, Jing C, Ting-Hong H. Comparison of equimolar doses of mannitol and hypertonic saline for the treatment of elevated intracranial pressure after traumatic brain injury: a systemic review and meta-analysis. Medicine. 2015;94(17):736–43.Google Scholar
  13. 13.
    Lee K. The NeuroICU book. USA: McGraw-Hill Medical; 2012.Google Scholar
  14. 14.
    Nirula R, Millar D, Greene T, et al. Decompressive craniectomy or medical management for refractory intracranial hypertension. J Trauma Acute Care Surg. 2014;76(4):944–55. doi: 10.1097/ta.0000000000000194.CrossRefPubMedGoogle Scholar
  15. 15.
    Lingsma HF, Roozenbeek B, Perel P, Roberts I, Maas AI, Steyerberg EW. Between-centre differences and treatment effects in randomized controlled trials: a case study in traumatic brain injury. Trials. 2011;12(1):201. doi: 10.1186/1745-6215-12-201.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Rowe AS, Goodwin H, Brophy G, et al. Seizure prophylaxis in neurocritical care: a review of evidence-based support. Pharmacotherapy. 2014;34(4):396–409.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.University of PittsburghPittsburghUSA

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