Increased Intracranial Pressure
(ICP)
Dr.Lizy Sonia Benjamin
Asst Professor
KKU, Abha
Introduction
l Normal ICP = 10 to 20 mm Hg
l Increased ICP refers to the pressure contained within
the cranial cavity.
l ICP more than 20 mm/Hg is considered elevated ICP,
also known as intracranial hypertension.
Components of the brain
● Brain tissue (1400 g),
● Blood (75 mL),
● CSF (75 mL)
l The volume and pressure of
these three components are
usually in a state of
equilibrium and produce the
Intracranial pressure (ICP)
0
Factors that influence ICP
1. Arterial pressure
2. Venous pressure
3. Intraabdominal and intrathoracic pressure
4. Posture
5. Temperature
6. Blood gases (CO2 levels)
0
Regulation and Maintenance for
ICP
• If the volume in any one of the
components (brain tissue, blood, and
CSF)
• increases within the cranial vault and the
volume from another component is
displaced, the total intracranial volume
will not change
0
Causes of increased ICP
• Brain tumor
• Cerebral edema
• Head injury
• Brain inflammation
• Metabolic encephalopathy
0
Clinical Manifestations
l LOC and later by abnormal respiratory and vasomotor
responses.
l Slowing of speech and delay in response to verbal suggestions
are other early indicators.
l Restlessness, confusion, or increasing drowsiness, has
neurologic significance.
l These signs may result from :
- compression due to swelling from hemorrhage or edema
- Hematoma or tumor
- combination of both
Contd
l As ICP increases, the patient becomes stuporous
(reacting only to loud auditory or painful stimuli)
l As neurologic function deteriorates further, the patient
becomes comatose and exhibits abnormal motor
responses in the form of decorticate or decerebrate
posture
l When the coma is profound, with the pupils dilated and
fixed and respirations impaired, death is usually
inevitable
Assessment
• Obtain a history of events leading to the present illness
Level of consciousness (LOC)
- eye opening
- verbal and motor responses
- pupils (size, equality, reaction to light)
☺ cranial nerve function
☺ cerebellar function (balance and coordination)
☺ reflexes
☺ motor and sensory function
• Glasgow Coma Scale
Diagnostic Findings
Cerebral angiography
CT scan
MRI Scan
Transcranial Doppler studies provide information about
cerebral blood flow. The patient with increased ICP may
also undergo electrophysiological monitoring to monitor
the pressure.
Lumbar puncture is avoided in patients with
increased ICP because the sudden release of pressure
can cause the brain to herniate.
Medical Management
l Increased ICP is a true emergency and must be treated
immediately through:
1- Invasive monitoring of ICP to :
► early identifying increased pressure
► quantify the degree of elevation
► initiate appropriate treatment
► provide access to CSF for sampling and drainage
► evaluate the effectiveness of treatment
Intracranial pressure monitoring is performed by inserting a catheter into the head
with a sensing device to monitor the pressure around the brain.
Medical Management
2- Decreasing cerebral edema:
► Osmotic diuretics - Mannitol
► Corticosteroids – Dexamethasone
● Barbiturates
● Antiseizure drugs
3- Maintaining cerebral perfusion:(>70 mm Hg)
► Maintain cardiac output
►Inotropic agents such as Dobutamine
Medical Management
3- Lowering the volume of CSF and cerebral blood:
► ventriculostomy
4- Controlling fever:
► fever increases cerebral metabolism
5- Maintaining oxygenation:
► Arterial blood gases must be monitored
► optimizing the hemoglobin saturation
Medical Management
6- Reducing metabolic demands:
► administration of high doses of barbiturates when
the patient is unresponsive to conventional treatment
► administration of pharmacologic paralyzing agents:
the patient cannot respond or report pain
7- Hyperventilation:
► Monitor PaCO2 (normal range 35 to 45 mm Hg)
► reduce ICP (by cerebral vasoconstriction and a
decrease in cerebral blood volume)
8- surgical intervention
• Optimizing cerebral tissue perfusion
• Maintain head alignment and elevate head of bed 30
degrees.
• The rationale is that hyperextension, rotation, or hyper
flexion of the neck causes decreased venous return.
• Avoid extreme hip flexion as this increases intra-
abdominal and intrathoracic pressures, leading to rise in
ICP.
• Avoid the Valsalva maneuver (straining at stool) as it
raises ICP. Administer stool softeners as prescribed. If
appropriate, provide high fiber diet.
• If abdominal distention present. Avoid enemas and
cathartics (sorbitol, magnesium citrate, sodium sulfate).
Nursing Care: Assessment
l Change in level of consciousness
l Changes in vital signs (Cushing triad)
1. Widening pulse pressure
2. Tachycardia /Bradycardia
3. Increased systolic BP
4. Irregular respirations
0
Contd….
l Ocular signs
l Decrease in motor strength and function
• Assess movement
• Assess response to stimuli
• Assess:
• Decerebrate posturing (extensor)
• Indicates more serious damage
• Decorticate posturing (flexor)
0
Decorticate and Decerebrate Posture
Contd….
l Headache : Often continuous and worse in the morning
l Vomiting : Projectile
l Hyperventilation therapy: suctioning →
hyperventilate with 100% oxygen
l Adequate oxygenation
• PaO2 maintenance at 100 mm Hg or greater
• ABG analysis guides the oxygen therapy
• May require mechanical ventilator
0
Contd….
l Nutritional therapy :
• Need for glucose
• IV 0.45% or 0.9% sodium chloride
● Body position maintained in head-up
position: elevate 30°
0
THANK YOU
