[Therapy for high intracranial pressure]

Raised intracranial pressure is the final common path to brain damage and brain death from a variety of intracranial conditions. Since the introduction of continuous monitoring of intracranial pressure into neurosurgical practice, much work has been undertaken which has advanced our knowledge of intracranial pressure and its management. The treatment of raised intracranial pressure should begin as soon as possible. The position of the head and neck should be checked to ensure that there is not an excessive degree of flexion or rotation. The airway should also be checked for obstruction and the patient observed to ensure that he is not making respiratory efforts against the respirator. The body temperature should not be above normal. Blood gases or other parameters of the adequacy of ventilation should be assessed and any abnormalities corrected. The sedation/analgesia regimen should be checked to ensure that it is sufficient and the patient is not experiencing pain. The serum sodium should be checked to ensure that hyponatraemia is not the cause of the intracranial hypertension. If intracranial hypertension persists despite the meticulous applications of these measures, then more specific therapy is required. This essentially reduces to a choice between osmotic agents, hypnotic drugs and drainage of cerebrospinal fluid.