Pathophysiology
Normal ICP: 5-15 mmHg. Increased ICP when intracranial volume exceeds capacity. Causes: edema, hemorrhage, tumor, hydrocephalus, infection. Sustained ICP >20 mmHg requires treatment.
Clinical Signs
Early: headache, vomiting, altered LOC, papilledema. Late (Cushing triad): bradycardia, irregular respirations, widened pulse pressure — brainstem compression. Unilateral pupil dilation, posturing.
Nursing Interventions
Elevate HOB 30°, head neutral, avoid hip flexion. PaCO2 35-40. Osmotherapy: mannitol 0.25-1 g/kg IV. Maintain CPP >60 (MAP 70-80, ICP <20). Control fever, prevent seizures. Neuro checks hourly.
Important Notes
- Cushing triad is a LATE sign — herniation may be imminent when it appears.
- Avoid Trendelenburg, hip flexion, and tight ET tube ties — all increase ICP.
Clinical Tips
- Use GCS for serial assessment — a 2-point drop warrants immediate notification.
- Mannitol can cause AKI — monitor serum osmolality (goal 300-320 mOsm/kg).
Summary
Increased ICP management requires head elevation, osmotic therapy, CPP optimization, and hourly neuro monitoring to prevent herniation.
