Self-assessment questions and answers

Question 2: How is acutely raised intracranial pressure managed?

Answer 2:

• Maintain perfusion by avoiding reductions in systemic blood

pressure while measures are taken to reduce the ICP.

• Remove the lesion or haematoma causing the increased ICP (if

possible).

• Adjust posture to 15-degree head-up tilt, provided blood

pressure is satisfactory.

• Osmotherapy (e.g. mannitol, hypertonic saline) will lead to a

short-lived reduction in ICP.

• Maintain adequate lung ventilation; deliberate hypocapnia can be

used as a temporary measure in extreme circumstances.

• Avoid coughing; neuromuscular blockade may lead to a small

decrease in ICP in any case.

• Avoid agents that are known to lead to cerebral vasodilatation

(including volatile anaesthetic agents).

• Arrange for ICP monitoring if the rise in ICP (or the risk of a rise)

is ongoing.