INTRACRANIAL PRESSURE

Intracranial Pressure
• Refers to the pressure contained within the cranial
cavity.
• The normal range is between 0 to 15 mmHg.
• ICP over 20 mm/Hg is considered elevated ICP, also
known as intracranial hypertension.
• The management team becomes concerned whenever a
patient’s ICP is over 15 mm/Hg, but is especially
concerned when it reaches levels of intracranial
hypertension.
 Intracranial Pressure

• Skull has three essential components:

- Brain tissue = 78%
- Blood = 12%
- Cerebrospinal fluid (CSF) = 10%

• Any increase in any of these tissues

causes increased ICP
Components of the Brain

Fig. 55-1
 Factors that influence ICP

1. Arterial pressure
2. Venous pressure
3. Intraabdominal and intrathoracic pressure
4. Posture
5. Temperature
6. Blood gases (CO2 levels)
 Intracranial Pressure

• The degree to which these factors  ICP

depends on the ability of the brain to
accommodate to the changes
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
 Intracranial Pressure
Regulation and Maintenance

• Normal compensatory adaptations

– Alteration of CSF absorption or
production
– Shunting of CSF into spinal
subarachnoid space
– Shunting of venous blood out of the
skull
 Mechanisms of Increased ICP

• Causes
– Mass lesion
– Cerebral edema
– Head injury
– Brain inflammation
– Metabolic insult
Increased Intracranial Pressure
Mechanisms of Increased ICP

• Sustained increases in ICP result in

brainstem compression and herniation of
the brain from one compartment to
another
Increased Intracranial Pressure

Fig. 55-3
Herniation

Fig. 55-4
SITES FOR ICP MONITORING

Epidural

Subarachnoid

Intraventricular
ICP mentoring system
ICP mentoring system
 Nursing Care: Assessment
• Change in level of consciousness
• Changes in vital signs (Cushing triad)
– Widening pulse pressure
– Tachy/Bradycardia
– Increased systolic BP
– Irregular respirations
 Nursing Care: Assessment
• Ocular signs

• Decrease in motor strength and function

– Assess movement
– Assess response to stimuli
– Assess:
• Decerebrate posturing (extensor)
– Indicates more serious damage
• Decorticate posturing (flexor)
Decorticate and Decerebrate Posturing
 Nursing Care: Assessment

• Headache
– Often continuous and worse in the
morning
• Vomiting
– Not preceded by nausea
– Projectile
 Increased Intracranial Pressure
Collaborative Care
• Hyperventilation therapy: suctioning →
hyperventilate with 100% oxygen

• Adequate oxygenation
– PaO2 maintenance at 100 mm Hg or
greater
– ABG analysis guides the oxygen therapy
– May require mechanical ventilator
Increased Intracranial Pressure
Collaborative Care

• Drug therapy
– Mannitol
– Loop diuretics
– Corticosteroids
– Barbiturates
– Antiseizure drugs
Increased Intracranial Pressure
Collaborative Care

• Nutritional therapy
– Patient is in hypermetabolic and
hypercatabolic state
  Need for glucose
– Keep patient normovolemic
• IV 0.45% or 0.9% sodium chloride
Increased Intracranial Pressure
Nursing Management
Overall goals:

• ICP WNL
• Maintain patent airway
• Normal fluid and electrolyte balance
• No complications secondary to immobility
• Respiratory function
• Fluid and electrolyte balance
Increased Intracranial Pressure
Nursing Management

Overall goals (cont’d)

• Body position maintained in head-up

position: elevate HOB 30°
• Protection from injury: positioning/turning
• Pain control
• Psychological considerations