{"id":3173,"date":"2026-05-29T12:58:30","date_gmt":"2026-05-29T20:58:30","guid":{"rendered":"https:\/\/www.nicolekupchikconsulting.com\/news\/?p=3173"},"modified":"2026-05-29T12:58:32","modified_gmt":"2026-05-29T20:58:32","slug":"management-of-intracranial-hypertension","status":"publish","type":"post","link":"https:\/\/www.nicolekupchikconsulting.com\/news\/management-of-intracranial-hypertension\/","title":{"rendered":"Management of Intracranial Hypertension"},"content":{"rendered":"\n

When caring for someone with increased ICP, here are some management strategies to think about!\u00a0 Here are very easy things you can do as a nurse to more complicated and emergent strategies!<\/p>\n\n\n\n

Positioning<\/td>
– Keep HOB > 30 – 45 degrees
– Keep head, neck, trunk midline – assess alignment
– Straight legs
– Decrease stimuli \u00a0<\/td><\/tr>
Stool softeners<\/td>
– Prevents straining and increasing intrathoracic pressure which = increased ICP<\/td><\/tr>
Pain<\/td>
– Assess & treat pain; it is common in neuro injuries<\/td><\/tr>
Temperature management<\/td>– Normothermia
– Avoid & treat fevers<\/strong>; lower core temperatures reduce brain metabolism & prevent secondary brain injuries<\/td><\/tr>
Airway management & Hyperventilation<\/td>– Airway protection – intubate if appropriate
– Mild hyperventilation \u00a0

CAUTION!<\/strong>
– Decreased CO2<\/sub> causes vasoconstriction which leads to decreased cerebral blood flow!
– Increased CO2<\/sub> causes vasodilation.
– Keep EtCO2<\/sub>\/PaCO2<\/sub> low normal 35 – 40 mm Hg; this is only possible if vented.<\/td><\/tr>
Pharmacological<\/td>
Sedation:
– Consider using short-acting sedatives such as propofol or dexmedetomidine (Precedex) if intubated \u00a0

Neuromuscular blockade (NMB)
– Priority: Patients need continuous sedation first to reach RASS goal; also consider pain meds
– Consider using the BIS monitor to target sedation levels!
– Cisatracurium or vecuronium:
PATIENTS MUST BE INTUBATED & SEDATED<\/strong>
– Assess Peripheral Nerve Stimulation via Train of Four (see graphic below)



– Goal is 1 – 2 twitches out of 4 \u00a0
– Barbiturates
– Pentobarbital
– Phenobarbital
– Thiopental
– Closely monitor for hypotension! \u00a0

Continuous EEG monitoring is often done with NMB or barbiturates because it is difficult to detect seizure activity!<\/em> \u00a0<\/strong><\/td><\/tr>
Noninvasive ICP Monitoring<\/td>
– Pupillometry
– Noninvasive ICP waveform analysis
– Transcranial Doppler
– Optic Nerve Ultrasound
– MRI\/CT \u00a0 \u00a0

***Some of these strategies are a snapshot of a patient\u2019s ICP data, but might be good for patients who cannot have invasive ICP monitoring \u00a0<\/td><\/tr>
Ventricular Drainage (EVD)<\/td>– EVD to manage hydrocephalus & drain excess CSF
– You can get ICP measurements as well – cannot do continuous ICP monitoring because the drain should not be routinely clamped<\/td><\/tr>
Surgical Intervention<\/td>– Decompressive craniectomy
– Used in refractory intracranial hypertension!
– Used when other approaches have failed.<\/td><\/tr>
Osmotic Therapy<\/td>– Mannitol 20% Osmotic Diuretic – WORKS FAST
0.25 to 1 gram\/kg IV bolus
Decreases ICP in 5 – 10 minutes
Max effect in 1 hour
Use a FILTER
– Hypertonic Saline
Continuous infusion 2%, 3%, 5%* 7%
(*central line required)
Bolus 23.4% for neuro emergencies
– Loop diuretics
Decrease intracranial volume \u00a0

Survival TIPS<\/strong> \u00a0
– Monitor LABS!
Osmolality, sodium & fluid status
Osmo no higher than 320 mOsm\/L (or as decided by a provider)
Potassium levels with mannitol!
– Monitor for rebound ICP
– Keep CPP > 60 mm Hg***
– The CPP is more dynamic than we thought\u00a0and the mean arterial blood pressure decreases
10 to 15 mm Hg before getting to the brain
– Use CPPot if technology is available or transcranial doppler \u00a0<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Stroke Awareness Month is almost over. If you want more information on recognizing strokes, treating them and preventing them, check out Nicole\u2019s on demand online Stroke Review Bootcamp course<\/a> – Receive 30% off enrollment – no code required – through 5\/31!<\/p>\n\n\n\n

References:<\/h2>\n\n\n\n

Intracranial Pressure Monitoring: Background, Indications, Contraindications<\/a><\/p>\n\n\n\n

Evaluation and management of elevated intracranial pressure in adults – UpToDate<\/a><\/p>\n\n\n\n

Management of acute moderate and severe traumatic brain injury in adults – UpToDate<\/a><\/p>\n\n\n\n

Monro-Kellie 4.0: moving from intracranial pressure to intracranial dynamics | Critical Care | Springer Nature Link<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

When caring for someone with increased ICP, here are some management strategies to think about!\u00a0 Here are very easy things you can do as a nurse to more complicated and emergent strategies! Positioning – Keep HOB > 30 – 45 degrees– Keep head, neck, trunk midline – assess alignment– Straight legs– Decrease stimuli \u00a0 Stool […]<\/p>\n","protected":false},"author":11,"featured_media":3185,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[46],"tags":[],"ppma_author":[62],"class_list":["post-3173","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nurse-education"],"yoast_head":"\r\nManagement of Intracranial Hypertension - Nicole Kupchik Blog<\/title>\r\n<meta name=\"description\" content=\"Strategies when caring for a patient with increased ICP.\" \/>\r\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\r\n<link rel=\"canonical\" href=\"https:\/\/www.nicolekupchikconsulting.com\/news\/management-of-intracranial-hypertension\/\" \/>\r\n<meta property=\"og:locale\" content=\"en_US\" \/>\r\n<meta property=\"og:type\" content=\"article\" \/>\r\n<meta property=\"og:title\" content=\"Management of Intracranial Hypertension - 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