An evidence-based approach to management of increased intracranial pressure

Current treatment of many conditions associated with elevated ICP of the brain involves stabilization and oxygenation with maintenance of adequate perfusion of cerebral tissue, while maintaining an acceptable ICP. As an example of a standard protocol that is in concordance with what is already known about a patient with a severe head injury, the first priority is radiographic screening for a surgical lesion. Further treatment, as shown by the previously outlined studies, includes keeping the patient normothermic, normoglycemic, and normocapnic, and placing an indwelling ICP monitor. Acutely elevated ICP is treated with mannitol, and if this fails, patients are routinely sedated, paralyzed, and mildly hyperventilated, while repeat radiology is obtained to rule out a further surgical lesion. Hypothermia, aggressive hyperventilation, and barbiturate coma continue to be used and are reserved for intractable ICP elevation, or as warranted based on a specific patient (Table 2).