Other last-resort or second-tier therapies for persistently elevated ICP include: Lumbar drain for CSF removal can only be used if the patient has a functioning external ventriculostomy, patent basal cisterns and no evidence of mass lesions on CT. Decompressive craniectomy is removal of part of the skull to allow the brain to expand and therefore decrease ICP. This has actually been shown to be effective in infants who are victims of intentional TBI. The pediatric guidelines on severe TBI suggested this therapy was most appropriate with the following: diffuse cerebral edema within 48 hours of injury no episodes of sustained ICP > 40 GCS > 3 at some point after injury a secondary clinical deterioration or evolving brain herniation The literature does not support the use of steroids unless there is documented cortisol deficiency. Nutritional supplementation should begin by 72 hours. "Severe" Pages: Previous 1 2 3 4 5 6