How is increased intracranial pressure treated in a neuro-ICU?
Once ICP is monitored, elevations can be detected and treated before serious brain damage occurs. Measures to reduce ICP include: • Removal of an intracranial mass lesion or CSF. The former can be accomplished surgically, the latter is accomplished via drainage with an intraventricular catheter. • Sedation. Agitated patients with elevated ICP are sedated to avoid further increases in blood pressure and intracranial pressure. • Blood pressure control. Once the patient is in a quiet, motionless state, attention is directed to manipulation of systemic blood pressure. Cerebral perfusion pressure, defined as mean arterial BP minus ICP, should be maintained between 70 mm Hg and 120 mm Hg. If CPP is below this level, drugs can be administered to increase mean BP. Similarly, if CPP is above this level, drugs can be administered to reduce mean BP, which sometime is associated with parallel reduction of ICP. • Mannitol. This treatment removes water from swollen brain tissue and is very effective
