Elevated intracranial pressure (ICP) in children: Management
- Robert C Tasker, MBBS, MD
Robert C Tasker, MBBS, MD
- Professor of Neurology and Anaesthesia (Pediatrics)
- Harvard Medical School
- Section Editors
- Susan B Torrey, MD
Susan B Torrey, MD
- Section Editor — Pediatric Resuscitation; Pediatric Trauma
- Director, Division of Pediatric Emergency Medicine
- Associate Professor of Emergency Medicine and Pediatrics (Clinical)
- NYU School of Medicine
- Adrienne G Randolph, MD, MSc
Adrienne G Randolph, MD, MSc
- Section Editor — Pediatric Critical Care Medicine
- Professor of Anaesthesia and Pediatrics
- Harvard Medical School
- Marc C Patterson, MD, FRACP
Marc C Patterson, MD, FRACP
- Section Editor — Pediatric Neurology
- Professor of Neurology, Pediatrics, and Medical Genetics
- Chair, Division of Child and Adolescent Neurology
- Mayo Clinic College of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The management of elevated ICP in children will be reviewed here.
The clinical manifestations and diagnosis of elevated intracranial pressure in children and the initial approach to severe traumatic brain injury in children is discussed separately. (See "Elevated intracranial pressure (ICP) in children: Clinical manifestations and diagnosis" and "Severe traumatic brain injury in children: Initial evaluation and management".)
Although discussed separately, the assessment and management of elevated ICP are performed jointly in practice. Acutely elevated ICP should be suspected in children with any one of the following findings (see "Elevated intracranial pressure (ICP) in children: Clinical manifestations and diagnosis", section on 'Acutely elevated ICP'):
●Severe headache with vomiting
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- THRESHOLD FOR TREATMENT
- INITIAL STABILIZATION
- Temperature control
- Neurosurgical consultation
- TREATMENT OF ELEVATED ICP
- General measures for all patients
- Measures in intubated patients
- Medical treatment of sustained intracranial hypertension or impending herniation
- - Hyperosmolar therapy
- Hypertonic saline
- - Therapeutic hyperventilation
- Refractory intracranial hypertension
- Patients with vasogenic edema
- Contraindicated therapies
- ONGOING MANAGEMENT
- SUMMARY AND RECOMMENDATIONS