Podcast # 484: Elevated ICP

Contributor: Charleen Gnisci, PharmD

Educational Pearls:

• Causes of increased intracranial pressure may include intracranial hemorrhage, malignancy, and trauma. 
• While definite treatment is to remove the offending cause, there are emergency medicine  
• Non-pharmacologic methods include elevating head of bed and removing noxious stimuli
• Pharmacologic options include mannitol and hypertonic saline
• Hypertonic saline is best delivered through a central line but not required
• Both these agents benefit from adequate renal function
• Before using mannitol, be sure to inspect the bag to ensure that it has not precipitated. If it has, try warming the bag before administration. 

References

https://pulmccm.org/critical-care-review/hyperosmolar-therapy-for-increased-intracranial-pressure-review-nejm/

Burgess S, Abu-Laban RB, Slavik RS, Vu EN, Zed PJ. A Systematic Review of Randomized Controlled Trials Comparing Hypertonic Sodium Solutions and Mannitol for Traumatic Brain Injury: Implications for Emergency Department Management. Ann Pharmacother. 2016 Apr;50(4):291-300. doi: 10.1177/1060028016628893. Epub 2016 Jan 29. Review. PubMed PMID: 26825644.

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD