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Management of Intracranial Pressure Part II

Nonpharmacologic Interventions

Sacco, Tara L., MS, RN, CCRN-K, AGCNS-BC, ACCNS-AG; Davis, Jenna Gonillo, MS, ACNPC-AG, CCRN

Dimensions of Critical Care Nursing: March/April 2019 - Volume 38 - Issue 2 - p 61–69
doi: 10.1097/DCC.0000000000000341
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Pharmacologic and nonpharmacologic interventions are available to treat patients who experience serious elevations in intracranial pressure (ICP). In some cases, patients may experience ICP that is refractory to treatment. Significant negative effects on cerebral blood flow, tissue oxygenation, and cerebral metabolism occur as a result of intracranial hypertension, leading to secondary brain injury. In part 2 of this series, nonpharmacologic interventions for ICP and ICP refractory to treatment are discussed. Interventions include neurologic monitoring (bedside assessment and multimodal monitoring), ventilatory support, fluid and electrolyte maintenance, targeted temperature management, and surgical intervention. Technology is always evolving, and the focus of multimodal monitoring here includes devices to monitor ICP, brain tissue oxygen tension, and cerebral blood flow and cerebral microdialysis monitors. Nursing care of these patients includes perspicacious assessment and integration of data, monitoring ventilatory and hemodynamic functioning, and appropriate patient positioning. Nurses must collaborate with the interprofessional care team to ensure favorable patient outcomes while utilizing an evidence-based guideline for the management of ICP.

Tara L. Sacco, MS, RN, CCRN-K, AGCNS-BC, ACCNS-AG, is a visiting assistant professor at Wegmans School of Nursing, St John Fisher College, Rochester, New York; and clinical nurse specialist at Adult Critical Care Nursing, University of Rochester Medical Center, Rochester, New York; and PhD student in the M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania; Jonas Scholar Cohort 2016-2018. Her research interests include quality improvement, critical care nursing, and nursing workforce support, specifically regarding compassion satisfaction and compassion fatigue. She is a member of the American Association of Critical-Care Nurses, Sigma Theta Tau International, National, the National Association of Clinical Nurse Specialists, and the Society of Trauma Nurses.

Jenna Gonillo Davis, MS, ACNPC-AG, CCRN, is critical care nurse practitioner in the Neuromedicine Intensive Care Unit, University of Rochester Medical Center, New York. Her research interests include nursing education, critical care nursing, and nursing workforce support, specifically regarding moral distress. She is a member of the American Association of Critical-Care Nurses, Sigma Theta Tau International, and the Neurocritical Care Society.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Address correspondence and reprint requests to: Tara L. Sacco, MS, RN, CCRN-K, AGCNS-BC, ACCNS-AG, Wegmans School of Nursing, St John Fisher College, 3690 East Ave, Rochester, NY 14620 (tsacco@sjfc.edu).

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