ICP ≤ 8
NO surgical lesion
Insert ICP Monitor: Ventriculostomy
preferred
Insert CVP and/or PA catheter as
needed
Surgical lesion
OR
Measure
CPP
Adults ≥ 60
Peds: see chart
Continue
present
care*
Sedation – 1st choice
propofol (Diprovan)
HOB @ 30°
Ç Drain EVD
Consider Repeat CT
ICP >20 and/or
CPP below target?
ICP >20 and/or
CPP below target?
Mannitol 1g/kg (1st dose) then 0.5 g/kg Q4h
Insert CVP or PA catheter as pt’s status dictates
Measure serum osmolarity and Na+, 2 hours after 1st
dose then q4h. Hold for osm>320 or Na >155 and call
Neurosurgery. Consider repeat CT if no improvement.
Continue
present
care*
ICPÈ
CPPÇ
ICP >20 and/or
CPP below target?
Insert PA catheter if not already present. Re-
assess fluid and cardiac status
Begin vasopressors (levophed or neosynephrine).
Titrate to CPP >60
ICP >20 and/or
CPP below target?
Call neurosurgery, consider second tier therapies
such a pentobarbital coma or decompressive
craniectomy
Consider repeat CT scan
Continue
present
care*
ICPÈ
CPPÇ
Continue
present
care*
ICPÈ
CPPÇ
Examine patient for correctable non-TBI causes of increased ICP or low CPP such as intra-abdominal hypertension, pneumothorax, cardiac failure, cardiac tamponadeor high PEEP
*Overall Management Strategies in Patients with Moderate to Severe Traumatic
Brain Injury
The algorithm provides a sequential and stepwise escalation in the treatment of patients with
moderate to severe traumatic brain injury. The following are some general management
strategies to decrease morbidity and mortality and improve overall outcome
Hypotension has been clearly demonstrated to be an independent predictor or worse outcome
following TBI, therefore a primary goal in patient management is judiciously avoid
hypotension ensuring adequate volume by:
•Transfusing to Hb of 10g/dl in the acute trauma patient
•Use FFP as volume if there is any coagulopathy
•Use of normal saline is the primary crystalloid solution for the first 24 hours (see
further fluid and sodium issues below)
•Consider using albumin an