Effective management of intracranial hypertension involves meticulous avoidance of factors that precipitate or aggravate increased intracranial pressure. When intracranial pressure becomes elevated, it is important to rule out new mass lesions that should be surgically evacuated. Medical management of increased intracranial pressure should include sedation, drainage of cerebrospinal fluid, and osmotherapy with either mannitol or hypertonic saline. For intracranial hypertension refractory to initial medical management, barbiturate coma, hypothermia, or decompressive craniectomy should be considered. Steroids are not indicated and may be harmful in the treatment of intracranial hypertension resulting from traumatic brain injury.
aDepartment of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA
bDepartment of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
Corresponding author.
This article was supported by National Institutes of Health grant P01-NS38660.
This is an updated version of an article that originally appeared in Critical Care Clinics, volume 22, issue 4.
ABSTRACT