Intracranial Pressure Management in Severe TBI

Dave McCreary

A bit of a refresher on ICP

ICP Monitoring

Severe head injury management

When the S**t hits the fan

CPP = MAP - ICP

CPP 55 – 95 mmHg

MAP > 80 mmHg

ICP < 20 mmHg

Widened Pulse Pressure

Irregular Breathing

Bradycardia

Brain Trauma Foundation Guidelines

All salvageable patients with sTBI and abnormal CTB (LEVEL II)

Patients with sTBI and NORMAL CTB with ≥ 2 of:• Age >40• Uni/Bilateral motor posturing• SBP < 90mmHg(LEVEL III)

Sats >95%

ETCO2 35-40 mmHg

PEEP <12

90 < SBP < 160 mmHg

80 ≤ MAP <110mmHg

Hb >100

What about when it hits the fan?

Blown Pupil(s)

Actual / impending herniation

Progressive Hypertension (>160) & Bradycardia (<60)

15-30 mins at ETCO2 30-35 mmHg

6ml/kg 5% Saline (Max 350ml)

Decompressive craniectomy

When death is imminent due to intracranial hypertension

braintrauma.org

trauma.org