At what ICP level should treatment be initiated?

Per BTF 2016 guidelines, ICP treatment thresholds should be >22 mmHg for severe TBI — the LEVEL II recommendation representing a change from the previous 20 mmHg threshold, based on the Seattle International Severe TBI Consensus Conference data showing reduced 6-month mortality with ≤22 mmHg target. First-tier interventions include head-of-bed elevation to 30°, sedation, analgesia, CSF drainage, and osmotherapy. Second-tier interventions (decompressive craniectomy, barbiturate coma, hypothermia) are reserved for refractory intracranial hypertension.

What is normal ICP and how does it vary with patient position?

Normal ICP in adults is 5–15 mmHg in the supine position. ICP decreases by approximately 5–10 mmHg in the upright position due to CSF redistribution. ICP ≥20 mmHg is elevated; ≥40 mmHg is severely elevated and acutely life-threatening. ICP is normally measured in mmHg but can be converted from cmH2O: 1 mmHg = 1.36 cmH2O. Waveform analysis (A waves = plateau waves indicating poor compliance; B waves = oscillations) provides additional information about brain compliance.

Intracranial Pressure Monitoring Calculator

Calculate CPP from ICP and MAP, convert ICP units (mmHg/cmH2O), and assess ICP thresholds for intervention in traumatic brain injury, hydrocephalus, and idiopathic intracranial hypertension.

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Frequently Asked Questions

At what ICP level should treatment be initiated?

What is normal ICP and how does it vary with patient position?