If ICP remains > 20, consider a repeat CT looking for surgical mass lesions. Second-tier, or last-resort, therapies that can be tried, in no particular order, include: Hypothermia (32-35.5o C. for 48 hours) - this has been shown to decrease mortality and severe disability following neonatal hypoxic-ischemic encephalopathy and in adults who remain comatose after a heart attack. RCTs are currently underway to evaluate this therapy in pediatric TBI. Aggressive hyperventilation (goal pCO2 < 30). While rapid lowering of the pCO2 by handbagging the patient is usually effective in an acute ICP spike, it is potentially very dangerous if used longer term because you are decreasing the ICP by decreasing the blood flow to the brain. Barbiturate coma - this decreases brain metabolic rate with resultant decrease in ICP. It also will depress the myocardium, so pressors/volume may be needed to maintain the MAP and CPP. Pentobarbital or thiopental can be used with the goal being burst-suppression on the EEG. "Severe" Pages: Previous 1 2 3 4 5 6 Next