ICP Control

Last modified by Hussein Abdallah on 2025/05/26 02:50

Contents

ICP Waveform Principles

P1 (Percussion)	P2 (Tidal)	P3 (Dicrotic)
arterial pulsation	intracranial compliance (elastance)	aortic valve closure
normally has the highest upstroke	early sign of high ICP is decreased compliance (hence higher wave)

Check that EVD is working
HOB > 30, can go up to 90 degrees
Avoid hypotension
Cool the patient to 32-33
Escalate sedation (prop / fentanyl boluses)
Make sure not wearing a C-collar unnecessarily (can compress jugular venous outflow)

Don't push sodium past 160 or osm past 320
Mannitol 0.5-1g/kg
- Not great for severe TBI, good for SAH
- mannitol also acts as free radical scavenger and decreases blood viscosity, transiently ↑ CBF
- Consider mostly in adults > children
HTS 6.5 - 10 mL
- Need to know most recent sodium then get q6

we do not like to do (takes a long time to leave system); most people will sooner consider a trip to OR
physiology of why PHB helps:
- decreased cerebral metabolic rate 2/2 decreased synaptic transmission
- promotes hypothermia
- increases intracerebral glucose/glucagon/phosphocreatine energy stores
- decrease nitrogen excretion
- shunts blood from normal --> hypoperfused regions
- endogenous anticonvulsant
- stabilizes lysosomal membranes
- decreases excitatory NT and Ca2+
- free radical scavenging (Thiopental)

On the way to OR, hyperventilate with EtCO2 goal 25-35 (this is not a long-term strategy)
- NOTE: PaCO2 < 25 (excessive hyperventilation) can cause ischemia