Management of intracranial hypertension.
Raised intracranial pressure (ICP) is a life threatening condition that is common to many neurological and non-neurological illnesses. Unless recognized and treated early it may cause secondary brain injury due to reduced cerebral perfusion pressure (CPP), and progress to brain herniation and death. Management of raised ICP includes care of airway, ventilation and oxygenation, adequate sedation and analgesia, neutral neck position, head end elevation by 20 degrees-30 degrees, and short-term hyperventilation (to achieve PCO(2) 32-35 mm Hg) and hyperosmolar therapy (mannitol or hypertonic saline) in critically raised ICP. Barbiturate coma, moderate hypothermia and surgical decompression may be helpful in refractory cases. Therapies aimed directly at keeping ICP <20 mmHg have resulted in improved survival and neurological outcome. Emerging evidence suggests that cerebral perfusion pressure targeted therapy may offer better outcome than ICP targeted therapies.
Singhi
Sunit C
SC
Pediatric Emergency Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Tiwari
Lokesh
L
D001463:Barbiturates / Q000627:therapeutic use; D002423:Cause of Death; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016292:Procedural Sedation / Q000379:methods*; D016638:Critical Illness / Q000628:therapy; D042241:Early Diagnosis; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D007427:Intracranial Pressure; D008297:Male; D008353:Mannitol / Q000627:therapeutic use*; D011379:Prognosis; D012121:Respiration, Artificial; D018570:Risk Assessment; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D016019:Survival Analysis
D001463:Barbiturates; D012462:Saline Solution, Hypertonic; D008353:Mannitol