Treatment of Intracranial tension is following except:
PEEP can increase intracranial tension. to reduce intracranial pressure1 Assessment and management of ABC's (airway, breathing, circulation)2 Early intubation if; GCS <8, Evidence of herniation, Apnea, Inability to maintain airway3 Mild head elevation of 15-30deg 4 Hyperventilation: Target PaCO2: 30-35 mm Hg (suited for acute, sharp increases in ICP or signs of impending herniation)5 Mannitol: Initial bolus: 0.25-1 g/kg, then 0.25-0.5 g/kg, q 2-6 h as per requirement, up to 48 h6 Hypeonic Saline: Preferable in presence of Hypotension,Hypovolemia, Serum osmolality >320 mOsm/kg, Renal failure,Dose: 0.1-1 ml/kg/hr infusion, Target Na+ -145-155 meq/L.7 Steroids: Intracranial tumors with perilesional edema, neurocysticerocosis with high lesion load, ADEM,pyomeningitis, TBM, Abscess Acetazolamide: Hydrocephalous, benign intracranial, high altitudeillness8 Adequate sedation and analgesia9 Prevention and treatment of seizures: use Lorazepam or midazolam followed by phenytoin as initial choice.10 Avoid noxious stimuli: use lignocaine prior to ET suctioning 11 Control fever: antipyretics, cooling measures12 Maintenance IV Fluids: Only isotonic or hypeonic fluids (Ringer lactate, 0.9% Saline, 5% D in 0.9% NS), No Hypotonic fluids13 Maintain blood sugar: 80-120 mg/dL14 Refractory raised ICP:* Heavy sedation and paralysis* Barbiturate coma* Hypothermia* Decompressive craniectomy
I.V. Frusemide
I.V. Mannitol
Controlled hyperventilation
Positive end pressure ventilation ( PEEP)
Intravenous Anesthetic Agents