Managing elevated intracranial pressure

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Abstract
Elevated intracranial pressure is one of the major deteriorating factors in patients with intracerebral lesions. Therefore, every year many experimental and clinical studies are performed to identify the best method for managing elevated intracranial pressure in head-injured patients. The current review summarizes the most important recent findings for the treatment of increased intracranial pressure.The currently most discussed treatments of elevated intracranial pressure are the use of hypertonic saline, which seems to be equal to mannitol, the use of hypothermia, and the performance of decompressive craniectomy.The treatment strategy to manage increased intracranial pressure includes decisions about anaesthetics, ventilation, head and body position, hypothermia, the use of osmotic drugs and surgical procedures. Propofol seems to be suitable for the sedation of patients with elevated intracranial pressure. Sudden increases in intracranial pressure can be treated using hyperosmotic agents, high-dose thiopental, or short episodes of mild hyperventilation. Surgical decompression of the cranium seems to improve the outcome in patients below the age of 50 years, especially children.