Intracranial Pressure Monitoring and Management

First Things First (assess & treat for the following)


  • 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.

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Last updated: April 28, 2010