Managing edema and intracranial pressure in the intensive care unit

Abstract

Despite several decades of intensive research efforts in the laboratory and the clinic, treatment for traumatic brain injury remains supportive and directed towards controlling intracranial pressure (ICP). First-line therapies for ICP control include positioning to promote jugular venous drainage, sedation and muscle relaxation, modest hyperventilation, and hyperosmolar therapy. Second-line therapies include barbiturate coma, systemic hypothermia, and decompressive craniectomy. Although all of these therapies can be used to treat intracranial hypertension, none have been shown to improve outcome in patients with TBI. This chapter reviews the current therapies used for ICP control with an emphasis on children with TBI.