Guidelines
Cook AM, Morgan Jones G, Hawryluk GWJ, et al. Guidelines for the acute treatment of cerebral edema in neurocritical care patients. Neurocrit Care. 2020;32(3):647-666. Carney N, Totten AM, O’Reilly C, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. NEUROSURGERY. 2017;80(1):6-15. Hemphill JC, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2015;46(7):2032-2060. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2019;50(12):e344-e418. Connolly ES, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. Stroke. 2012;43(6):1711-1737. Rajajee V, Riggs B, Seder DB. Emergency neurological life support: airway, ventilation, and sedation. Neurocrit Care. 2017;27(1):4-28.
Primary Literature
Hypertonic Saline
Tseng M-Y, Al-Rawi PG, Pickard JD, Rasulo FA, Kirkpatrick PJ. Effect of hypertonic saline on cerebral blood flow in poor-grade patients with subarachnoid hemorrhage. Stroke. 2003;34(6):1389–96. Hauer EM, Stark D, Staykov D, Steigleder T, Schwab S, Bardutzky J. Early continuous hypertonic saline infusion in patients with severe cerebrovascular disease. Crit Care Med. 2011;39(7):1766–72. Koenig MA, Bryan M, Lewin IJL, Mirski MA, Geocadin RG, Stevens RD. Reversal of transtentorial herniation with hypertonic saline. Neurology. 2008;70(13 part 1):1023–9. 11. Bentsen G, Breivik H, Lundar T, Stubhaug A. Hypertonic saline (7.2%) in 6% hydroxyethyl starch reduces intracranial pressure and improves hemodynamics in a placebo-controlled study involving stable patients with subarachnoid hemorrhage. Crit Care Med. 2006;34(12):2912–7. Bentsen G, Breivik H, Lundar T, Stubhaug A. Predictable reduction of intracranial hypertension with hypertonic saline hydroxyethyl starch: a prospective clinical trial in critically ill patients with subarachnoid haemorrhage. Acta Anaesthesiol Scand. 2004;48(9):1089–95. Al-Rawi PG, Tseng M-Y, Richards HK, et al. Hypertonic saline in patients with poor-grade subarachnoid hemorrhage improves cerebral blood flow, brain tissue oxygen, and pH. Stroke. 2010;41(1):122–8. Al-Rawi PG, Zygun D, Tseng MY, Hutchinson PJ, Matta BF, Kirkpatrick PJ. Cerebral blood flow augmentation in patients with severe subarachnoid haemorrhage. Acta Neurochir Suppl. 2005;95:123–7. Tseng M-Y, Al-Rawi PG, Czosnyka M, et al. Enhancement of cerebral blood flow using systemic hypertonic saline therapy improves outcome in patients with poor-grade spontaneous subarachnoid hemorrhage. J Neurosurg. 2007;107(2):274–82. Rockswold GL, Solid CA, Paredes-Andrade E, Rockswold SB, Jancik JT, Quickel RR. Hypertonic saline and its effect on intracranial pressure, cerebral perfusion pressure, and brain tissue oxygen. Neurosurgery. 2009;65(6):1035–41 (discussion 1041–1032). Lewandowski-Belfer JJ, Patel AV, Darracott RM, Jackson DA, Nordeen JD, Freeman WD. Safety and efficacy of repeated doses of 14.6 or 23.4% hypertonic saline for refractory intracranial hypertension. Neurocrit Care. 2014;20(3):436–42. Wells DL, Swanson JM, Wood GC, et al. The relationship between serum sodium and intracranial pressure when using hypertonic saline to target mild hypernatremia in patients with head trauma. Crit Care. 2012;16(5):R193. Ware ML, Nemani VM, Meeker M, Lee C, Morabito DJ, Manley GT. Effects of 23.4% sodium chloride solution in reducing intracranial pressure in patients with traumatic brain injury: a preliminary study. Neurosurgery. 2005;57(4):727–36. Qureshi AI, Suarez JI, Bhardwaj A, et al. Use of hypertonic (3%) saline/ acetate infusion in the treatment of cerebral edema: effect on intracranial pressure and lateral displacement of the brain. Crit Care Med. 1998;26(3):440–6. Bourdeaux CP, Brown JM. Randomized controlled trial comparing the effect of 8.4% sodium bicarbonate and 5% sodium chloride on raised intracranial pressure after traumatic brain injury. Neurocrit Care. 2011;15(1):42–5. Schwarz S, Georgiadis D, Aschof A, Schwab S. Effects of hypertonic (10%) saline in patients with raised intracranial pressure after stroke. Stroke. 2002;33(1):136–40. Berger-Pelleiter E, Emond M, Lauzier F, Shields JF, Turgeon AF. Hypertonic saline in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials. CJEM. 2016;18(2):112–20. Maguigan KL, Dennis BM, Hamblin SE, Guillamondegui OD. Method of hypertonic saline administration: efects on osmolality in traumatic brain injury patients. J Clin Neurosci. 2017;39:147–50. Froelich M, Ni Q, Wess C, Ougorets I, Hartl R. Continuous hypertonic saline therapy and the occurrence of complications in neurocritically ill patients. Crit Care Med. 2009;37(4):1433–41. Kerwin AJ, Schinco MA, Tepas JJ 3rd, Renfro WH, Vitarbo EA, Muehlberger M. The use of 23.4% hypertonic saline for the management of elevated intracranial pressure in patients with severe traumatic brain injury: a pilot study. J Trauma. 2009;67(2):277–82. Suarez JI, Qureshi AI, Parekh PD, et al. Administration of hypertonic (3%) sodium chloride/acetate in hyponatremic patients with symptomatic vasospasm following subarachnoid hemorrhage. J Neurosurg Anesthesiol. 1999;11(3):178–8. Shackford SR, Bourguignon PR, Wald SL, Rogers FB, Osler TM, Clark DE. Hypertonic saline resuscitation of patients with head injury: a prospective, randomized clinical trial. J Trauma. 1998;44(1):50–8. Schatzmann C, Heissler HE, Konig K, et al. Treatment of elevated intracranial pressure by infusions of 10% saline in severely head injured patients. Acta Neurochir Suppl. 1998;71:31–3. Qureshi AI, Suarez JI, Castro A, Bhardwaj A. Use of hypertonic saline/acetate infusion in treatment of cerebral edema in patients with head trauma: experience at a single center. J Trauma. 1999;47(4):659–65. Horn P, Munch E, Vajkoczy P, et al. Hypertonic saline solution for control of elevated intracranial pressure in patients with exhausted response to mannitol and barbiturates. Neurol Res. 1999;21(8):758–64. Munar F, Ferrer AM, de Nadal M, et al. Cerebral hemodynamic effects of 7.2% hypertonic saline in patients with head injury and raised intracranial pressure. J Neurotrauma. 2000;17(1):41–51. Huang SJ, Chang L, Han YY, Lee YC, Tu YK. Efficacy and safety of hypertonic saline solutions in the treatment of severe head injury. Surg Neurol. 2006;65(6):539–46. Dunham CM, Malik RJ, Huang GS, Kohli CM, Brocker BP, Ugokwe KT. Hypertonic saline administration and complex traumatic brain injury outcomes: a retrospective study. Int J Burns Trauma. 2018;8(3):40–53.
Mannitol
Misra UK, Kalita J, Ranjan P, Mandal SK. Mannitol in intracerebral hemorrhage: a randomized controlled study. J Neurol Sci. 2005;234(1–2):41–5. Sun S, Li Y, Zhang H, et al. The effect of mannitol in the early stage of supratentorial hypertensive intracerebral hemorrhage: a systematic review and meta-analysis. World Neurosurg. 2019;124:386–96. Aminmansour B, Tabesh H, Rezvani M, Poorjafari H. Effects of mannitol 20% on outcomes in nontraumatic intracerebral hemorrhage. Adv Biomed Res. 2017;6:75. Manno EM, Adams RE, Derdeyn CP, Powers WJ, Diringer MN. The effects of mannitol on cerebral edema after large hemispheric cerebral infarct. Neurology. 1999;52(3):583–7. Papagianni M, Tziomalos K, Kostaki S, et al. Treatment with Mannitol is associated with increased risk for in-hospital mortality in patients with acute ischemic stroke and cerebral Edema. Am J Cardiovasc Drugs. 2018;18(5):397–403. Bereczki D, Mihalka L, Szatmari S, et al. Mannitol use in acute stroke: case fatality at 30 days and 1 year. Stroke. 2003;34(7):1730–5. Bereczki D, Fekete I, Prado GF, Liu M. Mannitol for acute stroke. Cochrane Database Syst Rev. 2007;3:CD001153. Dziedzic T, Szczudlik A, Klimkowicz A, Rog TM, Slowik A. Is mannitol safe for patients with intracerebral hemorrhages? Renal considerations. Clin Neurol Neurosurg. 2003;105(2):87–9. Dorman HR, Sondheimer JH, Cadnapaphornchai P. Mannitol-induced acute renal failure. Medicine (Baltimore). 1990;69(3):153–9. Lin S-Y, Tang S-C, Tsai L-K, et al. Incidence and risk factors for acute kidney injury following mannitol infusion in patients with acute stroke: a retrospective cohort study. Medicine. 2015;94(47):e2032. Hartl R, Bardt TF, Kiening KL, Sarrafzadeh AS, Schneider GH, Unterberg AW. Mannitol decreases ICP but does not improve brain-tissue pO2 in severely head-injured patients with intracranial hypertension. Acta Neurochir Suppl. 1997;70:40–2. Smedema RJ, Gaab MR, Heissler HE. A comparison study between mannitol and glycerol therapy in reducing intracranial pressure. In: Avezaat CJJ, Eijndhoven JHM, van Maas AIR, Tans JTJ, editors. Proceedings of the 8th International Symposium on Intracranial Pressure, Held in Rotterdam, The Netherlands, June 16–20, 1991. New York: Springer; 1993. p. 605–608. Smith HP, Kelly DL Jr, McWhorter JM, et al. Comparison of mannitol regimens in patients with severe head injury undergoing intracranial monitoring. J Neurosurg. 1986;65(6):820–4. Videen TO, Zazulia AR, Manno EM, et al. Mannitol bolus preferentially shrinks non-infarcted brain in patients with ischemic stroke. Neurology. 2001;57(11):2120–2.
Hypertonic Saline vs. Mannitol
Battison C, Andrews PJD, Graham C, Petty T. Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury. Crit Care Med. 2005;33(1):196–8. Harutjunyan L, Holz C, Rieger A, Menzel M, Grond S, Soukup JA. Efficiency of 7.2% hypertonic saline hydroxyethyl starch 200/0.5 versus mannitol 15% in the treatment of increased intracranial pressure in neurosurgical patients—a randomized clinical trial [ISRCTN62699180]. Crit Care. 2005;9(5):R530–40. Francony G, Fauvage B, Falcon D, et al. Equimolar doses of mannitol and hypertonic saline in the treatment of increased intracranial pressure. Crit Care Med. 2008;36(3):795–800. Cottenceau V, Masson F, Mahamid E, et al. Comparison of effects of equiosmolar doses of mannitol and hypertonic saline on cerebral blood flow and metabolism in traumatic brain injury. J Neurotrauma. 2011;28(10):2003–12. Sakellaridis N, Pavlou E, Karatzas S, et al. Comparison of mannitol and hypertonic saline in the treatment of severe brain injuries. J Neurosurg. 2011;114(2):545–8. Ichai C, Armando G, Orban J-C, et al. Sodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients. Intensive Care Med. 2009;35(3):471–9. Li M, Chen T, Chen SD, Cai J, Hu YH. Comparison of equimolar doses of mannitol and hypertonic saline for the treatment of elevated intracranial pressure after traumatic brain injury: a systematic review and meta-analysis. Medicine (Baltimore). 2015;94(17):e736. Jagannatha AT, Sriganesh K, Devi BI, Rao GSU. An equiosmolar study on early intracranial physiology and long term outcome in severe traumatic brain injury comparing mannitol and hypertonic saline. J Clin Neurosci. 2016;27:68–73. Diringer MN, Scalfani MT, Zazulia AR, Videen TO, Dhar R. Cerebral hemodynamic and metabolic effects of equi-osmolar doses mannitol and 23.4% saline in patients with edema following large ischemic stroke. Neurocrit Care. 2011;14(1):11–7. Scwarz S, Schwab S, Bertram M, Aschof A, Hacke W. Effects of hypertonic saline hydroxyethyl starch solution and mannitol in patients with increased intracranial pressure after stroke. Stroke. 1998;29(8):1550–5. Asehnoune K, Lasocki S, Seguin P, et al. Association between continuous hyperosmolar therapy and survival in patients with traumatic brain injury—a multicentre prospective cohort study and systematic review. Crit Care. 2017;21(1):328. Vialet R, Albanese J, Thomachot L, et al. Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2 mL/kg 7.5% saline is more efective than 2 mL/kg 20% mannitol. Crit Care Med. 2003;31(6):1683–7. Oddo M, Levine JM, Frangos S, et al. Effect of mannitol and hypertonic saline on cerebral oxygenation in patients with severe traumatic brain injury and refractory intracranial hypertension. J Neurol Neurosurg Psychiatry. 2009;80(8):916–20. Chatterjee N, Chaudhury A, Mukherjee S, Prusty GK, Chattopadhyay T, Saha S. Efficacy of different hypertonic solutes in the treatment of refractory intracranial hypertension in severe head injury patients: A comparative study of 2 ml/kg 7.5% hypertonic saline and 2 ml/kg 20% mannitol. Indian J Neurotrauma. 2007;4(2):101–8. Cheng F, Xu M, Liu H, Wang W, Wang Z. A retrospective study of intracranial pressure in head-injured patients undergoing decompressive craniectomy: a comparison of hypertonic saline and mannitol. Front Neurol. 2018;9:631. Patil H, Gupta R. A comparative study of bolus dose of hypertonic saline, mannitol, and mannitol plus glycerol combination in patients with severe traumatic brain injury. World Neurosurg. 2019;125:e221–8. Mangat HS, Wu X, Gerber LM, et al. Hypertonic saline is superior to mannitol for the combined efect on intracranial pressure and cerebral perfusion pressure burdens in patients with severe traumatic brain injury. Neurosurgery 2020;86(2):221–30.
Prehospital Hyperosmolar Therapy
Cooper DJ, Myles PS, McDermott FT, et al. Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA. 2004;291(11):1350–7. Bulger EM, May S, Brasel KJ, et al. Out-of-hospital hypertonic resuscitation following severe traumatic brain injury: a randomized controlled trial. JAMA. 2010;304(13):1455–64. Sayre MR, Daily SW, Stern SA, Storer DL, van Loveren HR, Hurst JM. Out-of-hospital administration of mannitol to head-injured patients does not change systolic blood pressure. Acad Emerg Med. 1996;3(9):840–8. Morrison LJ, Baker AJ, Rhind SG, et al. The Toronto prehospital hypertonic resuscitation–head injury and multiorgan dysfunction trial: feasibility study of a randomized controlled trial. J Crit Care. 2011;26(4):363–72.
Corticosteroids
Sedation
Werner C. [Effects of analgesia and sedation on cerebrovascular circulation, cerebral blood volume, cerebral metabolism and intracranial pressure]. Anaesthesist. 1995;44 Suppl 3:S566-572. Khallaf M, Thabet AM, Ali M, Sharkawy E, Abdel-rehim S. The effect of dexmedetomidine versus propofol in traumatic brain injury: evaluation of some hemodynamic and intracranial pressure changes. Egyptian Journal of Neurosurgery. 2019;34(1):17. Froese L, Dian J, Batson C, Gomez A, Unger B, Zeiler FA. Cerebrovascular response to propofol, fentanyl, and midazolam in moderate/severe traumatic brain injury: a scoping systematic review of the human and animal literature. Neurotrauma Reports. 2020;1(1):100-112. Oddo M, Crippa IA, Mehta S, et al. Optimizing sedation in patients with acute brain injury. Crit Care. 2016;20(1):128. Battaglini D, Anania P, Rocco PRM, et al. Escalate and de-escalate therapies for intracranial pressure control in traumatic brain injury. Front Neurol. 2020;11:564751. Hawryluk GWJ, Aguilera S, Buki A, et al. A management algorithm for patients with intracranial pressure monitoring: the seattle international severe traumatic brain injury consensus conference(Sibicc). Intensive Care Med. 2019;45(12):1783-1794. Marklund N. The neurological wake-up test—a role in neurocritical care monitoring of traumatic brain injury patients? Front Neurol. 2017;8:540. Schomer KJ, Sebat CM, Adams JY, Duby JJ, Shahlaie K, Louie EL. Dexmedetomidine for refractory intracranial hypertension. J Intensive Care Med. 2019;34(1):62-66. George S, Mathew J. Midazolam is effective in controlling intracranial pressure in severe traumatic brain injury. CHRISMED J Health Res. 2019;6(4):242. Farling PA, Johnston JR, Coppel DL. Propofol infusion for sedation of patients with head injury in intensive care.: A preliminary report. Anaesthesia. 1989;44(3):222-226. Shabana M. Outcome of sedation therapy using midazolam or propofol continuous infusion in patients with severe traumatic brain injury. Ain-Shams J Anaesthesiol. 2016;9(1):108. Spies C, Macguill M, Heymann A, et al. A prospective, randomized, double-blind, multicenter study comparing remifentanil with fentanyl in mechanically ventilated patients. Intensive Care Med. 2011;37(3):469–76. Devabhakthuni S, Armahizer MJ, Dasta JF, Kane-Gill SL. Analgosedation: a paradigm shift in intensive care unit sedation practice. Ann Pharmacother. 2012;46(4):530–40. Karabinis A, Mandragos K, Stergiopoulos S, et al. Safety and efcacy of analgesia-based sedation with remifentanil versus standard hypnotic-based regimens in intensive care unit patients with brain injuries: a randomised, controlled trial [ISRCTN50308308]. Crit Care. 2004;8(4):R268–80. Grof TM, Bledsoe KA. Evaluating the use of dexmedetomidine in neurocritical care patients. Neurocrit Care. 2010;12(3):356–61.
Barbituates
Levin AB, Duf TA, Javid MJ. Treatment of increased intracranial pressure: a comparison of different hyperosmotic agents and the use of thiopental. Neurosurgery. 1979;5(5):570–5. Schwartz ML, Tator CH, Rowed DW. The University of Toronto head injury treatment study: a prospective, randomized comparison of Pentobarbital and Mannitol. Can J Neurol Sci. 1984;11(4):434–40. Pérez-Bárcena J, Llompart-Pou JA, Homar J, et al. Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled trial. Critical Care. 2008;12(4):R112. Majdan M, Mauritz W, Wilbacher I, Brazinova A, Rusnak M, Leitgeb J. Barbiturates use and its effects in patients with severe traumatic brain injury in five european countries. Journal of Neurotrauma. 2013;30(1):23-29. Bassin SL, Bleck TP. Barbiturates for the treatment of intracranial hypertension after traumatic brain injury. Critical Care. 2008;12(5):185. Velle F, Lewén A, Howells T, Enblad P, Nilsson P. Intracranial pressure–based barbiturate coma treatment in children with refractory intracranial hypertension due to traumatic brain injury. Journal of Neurosurgery: Pediatrics. 2020;25(4):375-383. Chen HI, Malhotra NR, Oddo M, Heuer GG, Levine JM, LeRoux PD. Barbiturate infusion for intractable intracranial hypertension and its effect on brain oxygenation. Neurosurgery. 2008;63(5):880-887. Velle F, Lewén A, Howells T, Nilsson P, Enblad P. Temporal effects of barbiturate coma on intracranial pressure and compensatory reserve in children with traumatic brain injury. Acta Neurochir. 2021;163(2):489-498 .Eisenberg HM, Frankowski RF, Contant CF, Marshall LF, Walker MD, __. High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. Journal of Neurosurgery. 1988;69(1):15-23. Riker RR, Fraser GL, Wilkins ML. Comparing the bispectral index and suppression ratio with burst suppression of the electroencephalogram during pentobarbital infusions in adult intensive care patients. Pharmacotherapy. 2003;23(9):1087-1093. Marshall GT, James RF, Landman MP, et al. Pentobarbital coma for refractory intra-cranial hypertension after severe traumatic brain injury: mortality predictions and one-year outcomes in 55 patients. Journal of Trauma: Injury, Infection & Critical Care. 2010;69(2):275-283. Robinson N, Clancy M. In patients with head injury undergoing rapid sequence intubation, does pretreatment with intravenous lignocaine/lidocaine lead to an improved neurological outcome? A review of the literature. Emergency Medicine Journal. 2001;18(6):453-457. Kuzak N, Harrison DW, Zed PJ. Use of lidocaine and fentanyl premedication for neuroprotective rapid sequence intubation in the emergency department. CJEM. 2006;8(02):80-84.
Rapid Sequence Intubation
Moss E, Powell D, Gibson RM, McDowall DG. Efect of etomidate on intracranial pressure and cerebral perfusion pressure. Br J Anaesth. 1979;51(4):347–52. Bar-Joseph G, Guilburd Y, Tamir A, Guilburd JN. Efectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension. J Neurosurg Pediatr. 2009;4(1):40–6 Himmelseher S, Durieux ME. Revising a dogma: ketamine for patients with neurological injury? Anesth Analg. 2005;101(2):524–34. Hug CC Jr, McLeskey CH, Nahrwold ML, et al. Hemodynamic efects of propofol: data from over 25,000 patients. Anesth Analg. 1993;77(4 Suppl):S21–9. Kovarik WD, Mayberg TS, Lam AM, Mathisen TL, Winn HR. Succinylcholine does not change intracranial pressure, cerebral blood fow velocity, or the electroencephalogram in patients with neurologic injury. Anesth Analg. 1994;78(3):469–73. Patanwala AE, Erstad BL, Roe DJ, Sakles JC. Succinylcholine is associated with increased mortality when used for rapid sequence intubation of severely brain injured patients in the emergency department. Pharmacotherapy. 2016;36(1):5. Lee C, Jahr JS, Candiotti KA, et al. Reversal of profound neuromuscular block by sugammadex administered three minutes after rocuronium: a comparison with spontaneous recovery from succinylcholine. Anesthesiology. 2009;110(5):1020–5. S orensen MK, Bretlau C, Gatke MR, Sorensen AM, Rasmussen LS. Rapid sequence induction and intubation with rocuronium-sugammadex compared with succinylcholine: a randomized trial. Br J Anaesth. 2012;108(4):682–9.
Review Articles
Treggiari MM, Schutz N, Yanez ND, Romand J-A. Role of intracranial pressure values and patterns in predicting outcome in traumatic brain injury: a systematic review. Neurocrit Care. 2007;6(2):104–12. Peluso L, Monleon Lopez B, Badenes R. Sedation in TBI patients. In: Zhou Y, ed. Traumatic Brain Injury – Neurobiology, Diagnosis and Treatment. IntechOpen; 2019. Schizodimos T, Soulountsi V, Iasonidou C, Kapravelos N. An overview of management of intracranial hypertension in the intensive care unit. J Anesth. 2020;34(5):741-757. Rangel-Castillo L, Gopinath S, Robertson CS. Management of intracranial hypertension. Neurologic Clinics. 2008;26(2):521-541. Ragland J, Lee K. Critical care management and monitoring of intracranial pressure. J Neurocrit Care. 2016;9(2):105-112.
Podcasts & Medical Blogs
Rabbit Hole: Intracranial Pressure Management
