Template:Increased ICP treatment

Increased ICP Treatment

1. Ensure adequate sedation (prevent gag reflex)
2. IVF to goal MAP >80 (maintains cerebral perfusion)
3. Mannitol
   1. If SBP>90
      1. If SBP>90 in adults use hypertonic saline NaCl 5% 150ml over 10 min
   2. Reduces ICP w/in 30min; duration of action of 6-8hr
   3. Bolus 20% @ 0.25-1 gm/kg as rapid infusion
   4. Monitor I+O to maintain euvolemia
4. Hyperventilation
   1. No longer recommended as prophylactic intervention
      1. Hyperventilation to PaCO2 <25 never indicated
   2. Brief course only recommended if impending herniation (i.e., Cushing reflex)
      1. 1. Maintain PaCO2 28-35 (20 breaths/min)
5. Seizure
   1. Treat immediately
   2. Seizure prophylaxis reduces sz but does not improve long-term outcomes
6. Goal CPP ~60mmHg
   1. If MAP <80, then CPP<60
      1. consider crystalloids or colloids (plasma if INR>1.3)
      2. phenylephrine 10-100mcg/min, or other pressors prn
      3. transfuse PRBCs, Hb>7