Management of raised intracranial pressure.
Appropriate management of raised intracranial pressure begins with stabilization of the patient and simultaneous assessment of the level of sensorium and the cause of raised intracranial pressure. Stabilization is initiated with securing the airway, ventilation and circulatory function. The identification of surgically remediable conditions is a priority. Emergent use of external ventricular drain or ventriculo-peritoneal shunt may be lifesaving in selected patients. In children with severe coma, signs of herniation or acutely elevated intracranial pressure, treatment should be started prior to imaging or invasive monitoring. Emergent use of hyperventilation and mannitol are life saving in such situations. Medical management involves careful use of head elevation, osmotic agents, and avoiding hypotonic fluids. Appropriate care also includes avoidance of aggravating factors. For refractory intracranial hypertension, barbiturate coma, hypothermia, or decompressive craniectomy should be considered.
Sankhyan
Naveen
N
Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Vykunta Raju
K N
KN
Sharma
Suvasini
S
Gulati
Sheffali
S
D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*
J Trauma. 1995 Dec;39(6):1091-7; discussion 1097-9
7500400
Childs Nerv Syst. 2001 Feb;17(3):154-62
11305769
Lancet. 2005 Jun 4-10;365(9475):1957-9
15936423
Neurosurgery. 1979 Jan;4(1):48-52
450215
J Trauma. 2002 Sep;53(3):558-63
12352497
Curr Opin Anaesthesiol. 2007 Oct;20(5):414-26
17873594
Acta Neurochir (Wien). 1992;117(3-4):153-9
1414516
J Neurosurg. 1992 Oct;77(4):584-9
1527619
J Infect Dis. 1988 Aug;158(2):325-31
3042874
Anesthesiology. 1977 Aug;47(2):149-63
327858
J Neurosurg. 1980 May;52(5):693-9
7373397
Crit Care Med. 1999 Oct;27(10):2086-95
10548187
N Engl J Med. 2001 Feb 22;344(8):556-63
11207351
Neurosurgery. 2005 Apr;56(4):740-54; discussion 740-54
15792513
Clin Neurosurg. 1964;10:212-23
14095874
Neurocrit Care. 2004;1(4):435-40
16174946
Neurologist. 2006 Mar;12(2):59-73
16534443
Pediatr Crit Care Med. 2003 Jul;4(3 Suppl):S19-24
12847341
J Neurol Sci. 2007 Oct 15;261(1-2):157-66
17585941
J Neurotrauma. 1992 Mar;9 Suppl 1:S317-26
1588623
Cochrane Database Syst Rev. 2005 Jul 20;(3):CD004583
16034939
AACN Clin Issues. 2005 Apr-Jun;16(2):212-31; quiz 270-1
15876889
Neurocrit Care. 2008;8(2):241-6
17928962
Neurol Clin. 2008 May;26(2):521-41, x
18514825
J Neurosurg. 1992 Feb;76(2):207-11
1730949
Crit Care Med. 1997 Aug;25(8):1402-9
9267957
Crit Care Med. 2000 Apr;28(4):1136-43
10809295
J Trauma. 2001 Feb;50(2):367-83
11242309
Stroke. 2005 Feb;36(2):e4-6
15618446
N Engl J Med. 2008 Jun 5;358(23):2447-56
18525042
Cleve Clin J Med. 2004 Jan;71 Suppl 1:S9-13
14964472
Crit Care Med. 2002 Nov;30(11 Suppl):S393-401
12528780
Anesthesiology. 2002 Feb;96(2):416-21
11818776
Am J Ophthalmol. 2003 Apr;135(4):437-46
12654358
Anaesthesia. 2009 Sep;64(9):990-1003
19686485
Crit Care Med. 1998 Mar;26(3):440-6
9504569
J Trauma. 2003 Dec;55(6):1035-8
14676647