The initial management of increased ICP in a patient with severe TBI includes: Sedation and analgesia - Fentanyl and versed are often used; continuous propofol is contraindicated in pediatrics because of reports of severe metabolic acidosis and myocardial failure. Positioning of the head in the midline with the head of the bed elevated to 30 degrees is routine. Neuromuscular blockade is optional. Maintenance of MAP and CPP with volume and pressors PRN. Avoid hyperthermia and hyperglycemia - keep blood glucose < 150 mg/dL, with insulin if necessary. If ICP continues > 20, further treatment involves: Hyperosmolar therapy - this causes an osmotic diuresis which draws fluid from the brain. Either mannitol or hypertonic saline can be used. CSF drainage if a ventricular catheter has been inserted Mild hyperventilation (goal pCO2 30-35). This causes cerebral vasoconstriction, with resultant decreased cerebral blood volume and decreased ICP. "Severe" Pages: Previous 1 2 3 4 5 6 Next