Management of raised intracranial pressure in children

Abstract

Children suffer a significant number of head injuries as a result of their high activity levels, immature developmental skills and increased head-to-body mass ratio. Primary brain injury is irreversible, but secondary insults can be limited. Central to this is the management of raised intracranial pressure (ICP).

The pathophysiology of head injury can explain some of the causes of raised ICP. Monitoring of ICP is important and this is closely linked to the maintenance of an adequate cerebral perfusion pressure and the importance of normovolaemia.

Other interventions that have been shown to limit rises in ICP are appropriate use of positioning, mechanical ventilation and drug therapy. Less common therapies include jugular venous bulb oxygen saturation monitoring and the use of trometamol (THAM).

Most nursing interventions do not actively reduce ICP, but they are central to its management. Reducing stimuli, avoiding cluster care, manual hyperinflation and limiting routine endotracheal suction may prevent an accumulative rise in ICP.

Based on this literature review, it is possible to divide these interventions into first and second tier treatments, as shown in the protocol. Much of the suggested management will occur simultaneously, but it is important to assess the child’s own response to each intervention and thus tailor treatment to minimize secondary brain injury.