Critical Care Management and Monitoring of Intracranial Pressure

Abstract

Patients with brain injury of any etiology are at risk for developing increased intracranial pressure. Acute intracranial hypertension is a medical emergency requiring immediate intervention to prevent permanent damage to the brain. Intracranial pressure as an absolute value is not as valuable as when one investigates other important associated variables such as cerebral perfusion pressure and contributing factors for an adequate cerebral blood flow. This manuscript reviews a number of various interventions that can be used to treat acute intracranial hypertension and optimize cerebral perfusion pressure. Management options are presented in an algorithm-format focusing on current treatment strategies and treatment goals. In addition to the efficacy, clinicians must consider significant adverse events that are associated with each therapy prior to initiating treatment. The initial step includes elevation of head of the bed and adequate sedation followed by osmotic agents such as mannitol and hypertonic saline infusion. Hypothermia and pentobarbital therapy represent more aggressive steps, and utilize different mechanisms by which the pressure is controlled, likely causing significant reduction in metabolism. Surgical intervention may precede any medical therapy in order to provide more robust response in controlling intracranial hypertension in certain cases.