![]() ![]() This is a result of at least one of the following: 1) extrinsic mass lesion, 2) increase in blood volume, 3) increase in CSF volume, or 4) increase in brain tissue. Pathologic states within the intracranial vault result in an increase of volume. Normal ICP ranges 3-15 mmHg in the intensive care unit (ICU), ICP values less than 20 mmHg are generally accepted. In an average adult, the brain tissue volume is 1,400 mL the blood volume is 150 mL and the CSF volume is 150 mL. This intracranial space has three components: brain tissue, blood, and cerebrospinal fluid (CSF). The Monro-Kellie doctrine states that the intracranial space is a fixed volume inside the skull. Key Words: Intracranial pressure Intracranial hypertension Cerebral perfusion pressure Cerebral blood flow Hypothermia Osmotic agents Surgical intervention may precede any medical therapy in order to provide more robust response in controlling intracranial hypertension in certain cases. Hypothermia and pentobarbital therapy represent more aggressive steps, and utilize different mechanisms by which the pressure is controlled, likely causing significant reduction in metabolism. ![]() The initial step includes elevation of head of the bed and adequate sedation followed by osmotic agents such as mannitol and hypertonic saline infusion. In addition to the efficacy, clinicians must consider significant adverse events that are associated with each therapy prior to initiating treatment. ![]() Management options are presented in an algorithm-format focusing on current treatment strategies and treatment goals. This manuscript reviews a number of various interventions that can be used to treat acute intracranial hypertension and optimize cerebral perfusion pressure. Intracranial pressure as an absolute value is not as valuable as when one investigates other important associated variables such as cerebral perfusion pressure and contributing factors for an adequate cerebral blood flow. Acute intracranial hypertension is a medical emergency requiring immediate intervention to prevent permanent damage to the brain. Patients with brain injury of any etiology are at risk for developing increased intracranial pressure. ![]()
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