Intracranial Pressure (ICP)
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Intracranial Pressure
(ICP) Megan McClintock, MS, RN
11/4/11
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Normal Values
ICP 5-15 mm Hg CPP 60-100 mm Hg (< 50 is bad) CSF 20-30 mL/hr
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Factors Affecting ICP
Arterial & venous pressure (high or low) Intrabdominal/intrathoracic pressure Posture Temperature Blood gases (acidosis, hypoxia, high CO2)
All are potent vasodilators
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Compensation
Change in CSF volume Absorption/production Movement of CSF to the spinal subarachnoid space
Change in intracranial blood volume Collapse of cerebral veins/dural sinuses Cerebral vasoconstriction/dilation Change in venous outflow
Change in brain tissue volume Distension of dura Compression of brain tissue
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Symptoms of ICP
Change in LOC Most sensitive & reliable indicator of neuro status
Change in VS Cushing’s triad
Change in pupils Response to light, blurred vision, diplopia, eye
movements, papilledema
Change in motor function Hemiparesis/hemiplegia, decorticate or decerebrate
posturing
Headache Vomiting
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Diagnostic Testing
CT MRI Angiography Transcranial Doppler EEG, Evoked Potentials PET NO LP!!!!!!!!
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ICP Monitoring
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LICOX
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Assessment
Glasgow Coma Scale Pupils Cranial Nerves Eye movement Motor strength Vital signs (including respiratory pattern -
pg 1435)
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Treatment CSF drain, ICP monitoring ET tube/trach to keep PaO2 at 100, PaCO2 30-
35 Surgical removal of mass Hemicraniectomy Only light sedation (ie. Versed, Ativan) Be careful with drugs that alter the neuro state
Rapid-acting opioids (Morphine, Fentanyl) are best
Propofol is good (rapid-acting, short half-life) Avoid benzodiazepines
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Drugs
Mannitol Osmotic diuretic given intravenously Decreases ICP by plasma expansion and osmotic
effect
Hypertonic saline (3%) Can be as effective as mannitol or used concurrently Raises the osmolality of the ECF in the brain
Corticosteroids Used for vasogenic edema around tumors and
abscesses but not for head-injured patients
Barbiturates Reduce metabolic rate decreasing CBF and ICP
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Interventions
No fever or shivering (or agitation, pain, seizures) No Valsalva, coughing, sneezing Avoid restraints Family member at bedside Seizure precautions Quiet, non-stimulating environment Light touch and talk even if in a coma
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Interventions
Respiratory Patent airway Watch breathing patterns Side-lying Watch for snoring Careful use of suctioning HOB 30 degrees Prevent abdominal distension (NG tube – depends on
injury) Monitor ABGs
Nutrition
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Interventions
Fluid & Electrolytes Monitor closely (esp. Na, Gl, K, Mg, osmo) Watch for diabetes insipidus & SIADH (pg
1437)
Body position HOB 30 degrees No neck flexion Turn gently and slowly Avoid extreme hip flexion Prevent pain