Critical Care Scenarios Episode 97: Managing ICP crisis
Jan 7, 2026
Dive into the intricacies of managing elevated intracranial pressure with expert insights. Discover the importance of assessing the true nature of ICP spikes and the critical role of cerebral perfusion pressure. EVD troubleshooting tips reveal common complications while hyperosmolar therapies like 3% saline and mannitol are compared. Learn when to escalate care, the considerations for craniectomy, and the impacts of thoracoabdominal pressures on cerebral drainage. Plus, explore team communication during crises and strategies for optimizing patient outcomes.
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Distinguish Spikes From Sustained ICP Rise
- Check whether the ICP elevation is transient or sustained for 5–10 minutes before escalating.
- Treat persistent elevations seriously and begin troubleshooting and interventions promptly.
Focus On CPP, Not ICP Alone
- Always assess cerebral perfusion pressure (CPP) not just ICP; a higher CPP lessens immediate concern.
- If the aneurysm is secured you can tolerate higher blood pressure to preserve CPP.
Troubleshoot The EVD Before Acting
- Troubleshoot the EVD first: inspect waveform quality and confirm it drains.
- A flat or damped waveform suggests catheter obstruction and unreliable ICP reading.