Emergency management of increased intracranial pressure.
Primary neurological injury in children can be induced by diverse intrinsic and extrinsic factors including brain trauma, tumors, and intracranial infections. Regardless of etiology, increased intracranial pressure (ICP) as a result of the primary injury or delays in treatment may lead to secondary (preventable) brain injury. Therefore, early diagnosis and aggressive treatment of increased ICP is vital in preventing or limiting secondary brain injury in children with a neurological insult. Present management strategies to improve survival and neurological outcome focus on reducing ICP while optimizing cerebral perfusion and meeting cerebral metabolic demands. Targeted therapies for increased ICP must be considered and implemented as early as possible during and after the initial stabilization of the child. Thus, the emergency physician has a critical role to play in early identification and treatment of increased ICP. This article intends to identify those patients at risk of intracranial hypertension and present a framework for the emergency department investigation and treatment, in keeping with contemporary guidelines. Intensive care management and the treatment of refractory increases in ICP are also outlined.
Division of Critical Care, Department of Pediatrics, British Columbia Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada.
Alexander Fraser
AF
Pitfield
Allison B
AB
Carroll
Niranjan
N
Kissoon
D000698:Analgesia / Q000379:methods; D001463:Barbiturates / Q000627:therapeutic use; D001925:Brain Damage, Chronic / Q000209:etiology / Q000517:prevention & control; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control; D002648:Child; D003131:Combined Modality Therapy; D003399:Craniotomy; D003422:Critical Care / Q000379:methods / Q000592:standards; D003952:Diagnostic Imaging; D042241:Early Diagnosis; D004630:Emergencies; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards; D004677:Encephalocele / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006982:Hypertonic Solutions / Q000627:therapeutic use; D007003:Hypoglycemia / Q000209:etiology / Q000517:prevention & control; D007010:Hyponatremia / Q000209:etiology / Q000517:prevention & control; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000379:methods; D012307:Risk Factors; D012640:Seizures / Q000209:etiology / Q000517:prevention & control
D001463:Barbiturates; D006982:Hypertonic Solutions