What Do We Do When the ICP Goes Up?
Randall M Chesnut, Nancy Temkin, Jason Barber et al.
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In 30 seconds
This secondary analysis of the randomized BOOST II trial examined treatments given during brief, mild clinical intracranial hypertension episodes in patients monitored for intracranial pressure (ICP). Among 70 patients with 509 qualifying episodes, analgosedation adjustment and cerebrospinal fluid drainage were the most frequent interventions, used in 72% and 33% of full episodes, respectively. Treatment combinations were common, and most interventions could be administered at the bedside at the clinician’s discretion. The authors highlight limited evidence for analgosedation’s role and call for physiology-based guidance.
Key findings
- Among 70 patients, 509 qualifying episodes were identified, representing 71% of all clinical intracranial hypertension episodes.
- Analgosedation adjustment and cerebrospinal fluid drainage were used in 72% and 33% of full episodes, respectively.
- Agent combinations were used in 41% of full episodes and 46% of interventions within the first 15 min.
- Bedside-discretionary interventions accounted for 76% of treatments for full episodes and 69% of early interventions.
Why it matters
The analysis describes how ICP-lowering care was delivered in routine practice, rather than testing which intervention is most effective. Frequent use of analgosedation adjustment and combined treatments may complicate interpretation of treatment intensity and underscores the need to understand how protocols are implemented and to evaluate treatment choices against physiological rationale and outcomes.
What to keep in mind
This was a secondary analysis restricted to brief, mild episodes with complete datasets; the clinical reasoning behind intervention choices was unavailable, and the analysis does not establish treatment effectiveness.