Treatment Approaches in Intracranial Hypertension: A Review

Abstract

Intracranial hypertension is considered, when intracranial pressure (ICP) increases above 20 mmHg for a period of more than 5 min. A persistent rise in ICP produces compression effect over cerebral vasculature and reduces cerebral blood flow (CBF) and cerebral perfusion pressure (CPP). It results in brain stem compression and herniation, if left untreated. A systematic assessment of clinical status, serial and continuous monitoring of vital parameters and evidence based therapeutic regimen are required for the care of patient with intracranial hypertension. The treatment guidelines and practices related to the management of intracranial hypertension were identified through electronic databases: Medline and Cochrane library. Conservative interventions and surgical interventions are used when the clinical condition demands. Conservative interventions include osmotic therapy, analgesia, sedation and neuromuscular blocking agents, barbiturates, anti-seizure therapy and steroids. Head end elevation (15 to 30°), optimal hyperventilation, moderate hypothermia, avoidance of stimulations, fluid and electrolyte balance are some of the adjunct management strategies of ICP. CSF drainage, evacuation of mass lesion and decompressive craniectomy are the surgical interventions. Moreover, the success of ICP management depends on the control of ICP<20 mmHg (or age appropriate) and a CPP>50 (or age appropriate), as well as prevention of hypoxia and hypotension.