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The NeuroCritical Care Society also has some guidelines on managing increased ICP, although not specifically for peds.

Fred


________________________________
 From: marc guttman <[log in to unmask]>
To: [log in to unmask] 
Sent: Wednesday, October 16, 2013 3:48 PM
Subject: Re: Cushing Response
 

Thanks, Michael and Alice.

My understanding of mannitol is that it is generally recommended for treatment of elevated ICP from cellular and vasogenic edema, that it does reduce ICP, but we are without evidence as of now of whether it results in improved clinical outcomes.  Again, still recommended.  For emergent intervention, in the patient with rapid neurologic deterioration, do you recommend a bolus of 1g/kg.

Do you use mannitol and hypertonic saline?  I understood it to be one or the other with no clear benefit of one over the other, although small studies suggested slight benefit of hypertonic saline over mannitol.  What volume boluses of 3% saline do you use?  


Thanks again.

Best,
Marc
 
www.WeDiscover.net


________________________________
From: Michael Verive <[log in to unmask]>
To: [log in to unmask] 
Sent: Wednesday, October 16, 2013 5:53 PM
Subject: Re: Cushing Response


Yes - hyperventilation, mannitol, 3% hypertonic saline.  

Michael Verive, MD, FAAP

Sent from my iPhone


> On Oct 16, 2013, at 3:34 PM, Marc Guttman <[log in to unmask]> wrote:
> 
> Other than rapid surgical decompression, is there any other recommended intervention for significant bradycardia from a Cushing Response in the setting of increased ICP/herniation secondary to traumatic intracranial hemorrhage while waiting (hopefully very shortly) for neurosurgical intervention?
> 
> Thanks.
> 
> Best,
> Marc
> 
> www.WeDiscover.net
> 
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                http://listserv.brown.edu/ped-em-l.html


For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
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For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                http://listserv.brown.edu/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html