Intracranial Pressure Monitoring and Management

First Things First (assess & treat for the following)

ABCs

• Maintain cerebral perfusion pressure (CPP = MAP - ICP) at 60 mmHg or higher.
  • Consider monitoring intracranial pressure (ICP) with goal of < 20 mmHg
• Emergency treatment of herniation
  • Elevate head of the bed to 30 degrees and ensure head is midline
  • Hyperventilate to PaCO2 34-36 mmHg
  • Mannitol (0.25-1 g/kg) IV
    • If intravascular volume is compromised, consider instead 23.4% hypertonic saline (30 cc).
      • 23% hypertonic saline must be given through central venous line.