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Verticalization for Refractory Intracranial Hypertension: A Case Series
Brittany Bolduc Lachance1, WanTsu Chang2,3, Melissa Motta2
1Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA. blachance@som.umaryland.edu.
Neurocritical Care
|August 18, 2021
Summary
Verticalization effectively lowers intracranial pressure (ICP) in patients with refractory intracranial hypertension. This novel intervention reduced ICP and medical interventions, showing promise for severe cases.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Neurology
Background:
- Severe intracranial hypertension is a critical condition linked to high mortality rates.
- Standard management includes sedation, hyperosmotic agents, barbiturates, hypothermia, and surgery.
- Refractory intracranial hypertension, unresponsive to maximal treatment, carries a significant risk of herniation and death.
Purpose of the Study:
- To evaluate the efficacy of verticalization as a novel intervention for intracranial hypertension refractory to aggressive medical management.
- To assess the impact of verticalization on intracranial pressure (ICP) and the need for medical interventions.
Main Methods:
- A single-center retrospective review of six patients with refractory intracranial hypertension.
- Patients underwent verticalization for at least 24 hours after failing standard ICP-lowering algorithms.
- Comparison of median ICP, ICP spikes, and percentage of elevated ICP values before and after verticalization.
Main Results:
- Verticalization led to a significant reduction in median ICP (30 mmHg to 12 mmHg), ICP spikes, and percentage of elevated ICP values.
- A decrease in total medical interventions (79 to 41) and therapy intensity was observed post-verticalization.
- Common adverse effects included asymptomatic bradycardia and pressure wounds.
Conclusions:
- Verticalization is an effective noninvasive method for lowering ICP in patients with refractory intracranial hypertension.
- This intervention shows potential as an adjunct to aggressive standard management.
- Further research is warranted to explore the broader application of verticalization.
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