Management of increased intracranial pressure in the critically ill child with an acute neurological injury.
Increased intracranial pressure reflects the presence of mass effect in the brain and is associated with a poor outcome in children with acute neurological injury. If sustained, it has a negative effect on cerebral blood flow and cerebral perfusion pressure, can cause direct compression of vital cerebral structures, and can lead to herniation. The management of the patient with increased intracranial pressure involves the maintenance of an adequate cerebral perfusion pressure, prevention of intracranial hypertension, and optimization of oxygen delivery. This article reviews the neurological assessment, pathophysiology, and management of increased intracranial pressure in the critically ill child who has sustained an acute neurological injury.
Marcoux
Kelly Keefe
KK
Robert Wood Johnson Medical School, University of Medicine & Dentistry of New Jersey, Piscataway, NJ, USA. marcoukk@umdnj.edu
D000208:Acute Disease; D000465:Algorithms; D001921:Brain / Q000502:physiology / Q000503:physiopathology; D001930:Brain Injuries / Q000150:complications*; D002648:Child; D016292:Procedural Sedation / Q000379:methods / Q000451:nursing; D003391:Cranial Nerves / Q000502:physiology / Q000503:physiopathology; D003422:Critical Care / Q000379:methods*; D003663:Decision Trees; D004234:Diuretics, Osmotic / Q000627:therapeutic use; D005440:Fluid Therapy / Q000379:methods / Q000451:nursing; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D019586:Intracranial Hypertension / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008353:Mannitol / Q000627:therapeutic use; D008991:Monitoring, Physiologic / Q000379:methods / Q000451:nursing; D009460:Neurologic Examination / Q000379:methods / Q000451:nursing; D024802:Nurse's Role; D009730:Nursing Assessment; D010371:Pediatric Nursing / Q000379:methods; D011187:Posture; D012025:Reflex, Pupillary / Q000502:physiology; D012121:Respiration, Artificial / Q000379:methods / Q000451:nursing
D004234:Diuretics, Osmotic; D008353:Mannitol