Table 2: Summary of measures to control IC-HTN a Goals: Keep ICP < 22 mm Hg, and CPP ≥ 50 mm Hg
| Skill | Done Sufficiently (2) | Done Insufficiently (1) | Not Done (0) |
| General measures (should be utilized routinely) | |||
| Elevate head of the bed by 30 °C | |||
| Keep neck straight, avoid neck constrictions (tight trach tape, tight cervical collar...) | |||
| Control hypertension if present | |||
| Avoid arterial hypotension (SBP < 90 mm Hg) | |||
| Avoid hypoxia (PaO2 < 60 mm Hg or O2 sat < 90%) | |||
| Ventilate to normocarbia (PaCO2 = 35-40 mm Hg) | |||
| Light sedation: e.g. codeine 30-60 mg IM q 4 hrs PRN | |||
| Perform unenhanced head CT scan to identify etiology | |||
| Specific measures for ICH (proceed to successive steps if documented ICH persists - each step is ADDED to the previous measure) | |||
| Heavy sedation (e.g. fentanyl 1-2 ml or morphine 2-4 mg IV q 1 hr) and/or paralysis (e.g. vecuronium 8-10 mg IV) | |||
| Drain 3-5 ml CSF if intraventricular catheter is present | |||
| Hyperventilate to PaCO2 = 30-35 mm Hg ("blows off" CO2 ) | |||
| Mannitol 0.25-1 gm/kg, then 0.25 gm/kg q 6 hrs, increase dose if ICH persists & serum osmol ≤ 320 (NB: Skip this step if hypovolemia or hypotension) | |||
| If there is "osmotic room" (i.e., serum osmol < 320) bolus with 10-20 ml of 23.4% hypertonic saline | |||
| Augmented hyperventilation to ↓ PaCO2 to 25-30 mm Hg | |||
| If ICH persists, consider unenhanced head CT & EEG. Proceed to "second tier" therapy | |||