From the Guidelines
Intracranial hypertension treatment should be individualized and guided by a healthcare professional.
Initial Management
Initially, patients with mild to moderate intracranial hypertension may be managed with simple measures such as head positioning, analgesia, and sedation 1. Additionally, patients should be advised to maintain a normal weight, avoid tight clothing around the neck, and elevate the head of the bed by 30 degrees to reduce intracranial pressure.
Medical Management
In more severe cases, or if initial measures are not effective, other treatment options may include:
- Mannitol, administered as a 0.25-1 g/kg intravenous bolus, or
- Hypertonic saline, administered as a 3% solution at a dose of 1-2 mL/kg intravenously 1.
- Hyperosmolar therapy is the principal medical strategy in the treatment of cerebral edema, with mannitol or hypertonic saline being effective in treating acutely elevated ICPs 1.
Surgical Intervention
Close monitoring of the patient's neurological status, vision, and intracranial pressure is essential to adjust treatment as needed. In some cases, surgical intervention, such as a lumbar puncture or shunting procedure, may be necessary to relieve elevated intracranial pressure 1.
Key Considerations
It is essential to note that corticosteroids are not recommended for the management of cerebral edema and increased intracranial pressure following ischemic stroke 1. Furthermore, the use of osmotic agents should be carefully considered, with monitoring of fluid, sodium, and chloride balances necessary to avoid side effects such as osmotic diuresis, hypernatremia, and hyperchloremia 1.
From the FDA Drug Label
1 INDICATIONS & USAGE Mannitol Injection is indicated for the following purposes in adults and pediatric patients. Therapeutic Use Reduction of intracranial pressure and brain mass.
12 CLINICAL PHARMACOLOGY 12. 1 Mechanism of Action ... By increasing the osmotic pressure of plasma and the extracellular space, intravenously administered mannitol will induce the movement of intracellular water to the extracellular and vascular spaces. This action underlies the role of mannitol in reducing intracranial pressure, intracranial edema, and intraocular pressure.
The treatment option for Increased Intracranial Pressure (ICP) is Mannitol (IV), which works by increasing the osmotic pressure of plasma and the extracellular space to reduce intracranial pressure and intracranial edema 2 2.
- Key Mechanism: Osmotic diuretic effect
- Key Benefit: Reduction of intracranial pressure and brain mass
From the Research
Treatment Options for Increased Intracranial Pressure (ICP)
The treatment options for increased ICP can be categorized into several tiers, including:
- First-tier options:
- Second-tier options:
- Surgical options:
Considerations for Treatment
When selecting a treatment option, it is essential to consider the underlying cause of the increased ICP and the patient's individual circumstances 3, 4, 6. The treatment should be tailored to the specific needs of the patient, and the therapeutic value and appropriate timing of rescue treatments should be carefully evaluated 5. Additionally, the development and integration of different physiological variables through multimodality monitoring can provide more robust prognostic information to patients facing these challenging decisions 5.