EICP Case

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CASE HISTORY

Zamir Hassan is a 34 year old man involved in a high speed motor bike accident. He has many injuries including a severe TBI and he has been intubated for a decreased level of consciousness.
Prior to surgery for spinal fractures, an external ventricular drain was inserted to monitor and treat intracranial pressure.
During and after surgery his intracranial pressure was less than 15 mmHg. However on the day following surgery, when his sedation was ceased to neurologically assess him, the pressure rises to 25 mmhg.

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Why is the pressure going up now? Give a list of 4 possible explanations:


  1. Worsening cerebral oedema (cytotoxic and vasogenic)
  2. Expanding haematoma in any compartment
  3. Obstructive hydrocephalus (as drain clamped)
  4. Seizures

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This is clearly a problem so you summon help.
What are the first few things you should do in managing this?


  • Check the measurement is real
  • Open the EVD
  • Ensure no venous obstruction
  • Bolus sedation
  • Check the blood pressure and aim CPP 60-70 mmHg with fluids and vasopressors 
  • Ensure ventilator synchrony
  • Avoid unnecessary PEEP
  • Aim SpO2 > 94% and PaCO2 35-40 mmHg
  • Check sodium, aim 135 – 155 mmol/L
  • Make sure normothermic

We’ll expand on all of these more in this module….

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