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Management of Intracranial Pressure Part II: Nonpharmacologic Interventions.

Tara L Sacco1, Jenna Gonillo Davis

  • 1Tara L. Sacco, MS, RN, CCRN-K, AGCNS-BC, ACCNS-AG, is a visiting assistant professor at Wegmans School of Nursing, St John Fisher College, Rochester, New York; and clinical nurse specialist at Adult Critical Care Nursing, University of Rochester Medical Center, Rochester, New York; and PhD student in the M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, 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, National, the National Association of Clinical Nurse Specialists, and the Society of Trauma Nurses. Jenna Gonillo Davis, MS, ACNPC-AG, CCRN, is critical care nurse practitioner in the Neuromedicine Intensive Care Unit, University of Rochester Medical Center, New York. Her research interests include nursing education, critical care nursing, and nursing workforce support, specifically regarding moral distress. She is a member of the American Association of Critical-Care Nurses, Sigma Theta Tau International, and the Neurocritical Care Society.

Dimensions of Critical Care Nursing : DCCN
|February 1, 2019
PubMed
Summary

This study details nonpharmacologic strategies for managing elevated intracranial pressure (ICP) that resists treatment. Key interventions include advanced monitoring, ventilatory support, and temperature management to prevent secondary brain injury.

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Area of Science:

  • Neuroscience
  • Critical Care Medicine
  • Nursing

Background:

  • Elevated intracranial pressure (ICP) can lead to severe secondary brain injury.
  • ICP that is refractory to treatment presents a significant clinical challenge.
  • Effective management requires a comprehensive, evidence-based approach.

Purpose of the Study:

  • To discuss nonpharmacologic interventions for managing intracranial pressure (ICP).
  • To review strategies for ICP refractory to treatment.
  • To highlight the role of nursing in managing patients with elevated ICP.

Main Methods:

  • Neurologic monitoring, including bedside assessment and multimodal monitoring (ICP, brain tissue oxygen, cerebral blood flow, microdialysis).
  • Ventilatory support, fluid and electrolyte balance, and targeted temperature management.
  • Surgical interventions and optimized nursing care, emphasizing data integration and collaboration.

Main Results:

  • Nonpharmacologic interventions offer critical management options for elevated ICP.
  • Multimodal monitoring provides advanced insights into brain physiology.
  • Effective nursing care and interprofessional collaboration are vital for patient outcomes.

Conclusions:

  • Nonpharmacologic strategies are essential for managing refractory intracranial hypertension.
  • Technological advancements in monitoring enhance patient care.
  • Evidence-based nursing practice is crucial for optimizing outcomes in patients with elevated ICP.