What ICP level requires treatment?

ICP >22 mmHg (BTF 4th edition) in severe TBI requires treatment; CPP 60-70 mmHg target; stepwise approach: head elevation 30°, sedation/analgesia, CSF drainage, osmotherapy, decompressive craniectomy; avoid CPP-targeted therapy alone (fluid loading increases ARDS risk).

What mannitol dose reduces ICP?

Mannitol 0.25-1.5 g/kg IV bolus (20% solution); onset 15-30 min, duration 4-6h; serum osmolality <320 mOsm/kg to prevent renal failure; avoid with hypovolemia (diuretic effect may worsen hypotension); repeat dosing requires serum osmolality monitoring.

When is hypertonic saline preferred over mannitol?

Hypertonic saline (3% NaCl): preferred when hypotension is present (volume-expanding vs mannitol’s diuretic effect); 3% NaCl 150-300 mL boluses or 23.4% NaCl 30 mL; target serum Na 145-155 mEq/L; no renal toxicity threshold concerns; central line required for >3% NaCl.

What CT findings indicate decompressive craniectomy?

Malignant MCA stroke: decompressive hemicraniectomy within 48h for age <60 (DECIMAL, DESTINY, HAMLET trials): reduces mortality from 78% to 29%; modified Rankin ≤3 in 75% at 1 year; age 61-80 (DESTINY II): reduces mortality but more survivors with severe disability.

What temperature control reduces ICP?

Normothermia (36-37°C) reduces ICP by reducing CMRO2; fever treatment with paracetamol/NSAIDs/cooling blankets; prophylactic hypothermia does NOT improve TBI outcomes (Eurotherm3235 trial: hypothermia worsened outcomes); normothermia targeting is the current standard.

Intracranial Pressure and Cerebral Edema Management Calculator

Calculates ICP treatment thresholds, osmotherapy dosing (mannitol/hypertonic saline), CPP targets, and guides decompressive craniectomy criteria in severe TBI and malignant MCA stroke.

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Frequently Asked Questions

What ICP level requires treatment?

What mannitol dose reduces ICP?

When is hypertonic saline preferred over mannitol?

What CT findings indicate decompressive craniectomy?

What temperature control reduces ICP?