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Management of Intracranial Pressure: Part I: Pharmacologic Interventions.
Tara L Sacco1, Samantha A Delibert
1Tara L. Sacco, MS, RN, CCRN-K, AGCNS-BC, ACCNS-AG, is visiting assistant professor, Wegmans School of Nursing, St John Fisher College, Rochester, New York; clinical nurse specialist, Adult Critical Care Nursing, University of Rochester Medical Center, New York; and PhD student, College of Nursing, Villanova University, Pennsylvania/Jonas Scholar Cohort 2016-2018. Her research interests include quality improvement, critical care nursing, and nursing workforce support, specifically regarding compassion satisfaction and compassion fatigue. She is a member of the American Association of Critical-Care Nurses, Sigma Theta Tau International, and the Society of Trauma Nurses. Samantha A. Delibert, PharmD, BCCCP, is neuromedicine ICU clinical pharmacy specialist, University of Rochester Medical Center, New York. She is a memeber of the Neurocritical Care Society, The Society of Critical Care Medicine, and the American College of Clinical Pharmacy.
Refractory intracranial pressure (ICP) elevations after severe brain injury pose significant risks. Pharmacologic interventions like opioids, sedatives, and diuretics are discussed to manage ICP and prevent secondary brain injury.
Area of Science:
- Neuroscience
- Critical Care Medicine
- Pharmacology
Background:
- Severe brain injury can lead to dangerous, sustained elevations in intracranial pressure (ICP).
- Elevated ICP unresponsive to initial treatment is termed refractory ICP (rICP), posing a high risk for secondary brain injury and permanent dysfunction.
Purpose of the Study:
- To discuss pharmacologic interventions for managing elevated intracranial pressure (ICP) and refractory ICP (rICP).
- To highlight the role of specific drug classes in normalizing ICP and preventing secondary brain injury.
Main Methods:
- Review of pharmacologic interventions used in managing ICP and rICP.
- Discussion of drug classes including opioids, sedatives, osmotic diuretics, hypertonic saline, and barbiturates.
Main Results:
- Pharmacologic agents are crucial in attempting to normalize ICP.
- These interventions aim to prevent secondary brain injury in patients with elevated ICP.
Conclusions:
- Pharmacologic interventions are a key component in managing elevated and refractory ICP.
- Evidence-based guidelines for rICP management are essential for improving patient outcomes.
- Collaborative nursing care focusing on patient and family comfort is vital.
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