Critical Care Scenarios Episode 97: Managing ICP crisis
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Jan 7, 2026 Dive into the intricacies of managing elevated intracranial pressure with expert insights. Discover the importance of assessing the true nature of ICP spikes and the critical role of cerebral perfusion pressure. EVD troubleshooting tips reveal common complications while hyperosmolar therapies like 3% saline and mannitol are compared. Learn when to escalate care, the considerations for craniectomy, and the impacts of thoracoabdominal pressures on cerebral drainage. Plus, explore team communication during crises and strategies for optimizing patient outcomes.
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Place Central Access For High-Concentration Saline
- Place a central line early if you expect repeated high-concentration hypertonic therapy.
- Prefer subclavian access to avoid potential venous drainage obstruction, and use femoral if necessary.
Use EVD As A Therapeutic Pop-Off
- Use the EVD therapeutically: open or lower the drain and remove small aliquots (e.g., ~5 mL) rather than leaving it wide open.
- Avoid overdraining and coordinate amounts with neurosurgery.
Use Rescue Hyperventilation Short-Term
- If basic measures fail, hyperventilate as a short-term rescue to lower PaCO2 and reduce cerebral blood volume.
- Aim for low-normal ETCO2 (~30 mmHg) and consider mid-20s only as a desperate temporizing measure.