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Raised intracranial pressure after TBI — FRCA Final MCQ

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HardICURaised intracranial pressure after TBIFRCA Final

A 29-year-old motorcyclist with severe traumatic brain injury is ventilated on ICU. CT shows cerebral oedema without operable haematoma; ICP is 32 mmHg, MAP is 72 mmHg, PaCO2 is 6.2 kPa and temperature is 38.6°C. What is the most appropriate management?

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Correct answer: D — Optimise ventilation, treat fever and give hypertonic saline while maintaining cerebral perfusion

Raised ICP requires prevention of secondary brain injury: adequate oxygenation, normocapnia or short-term controlled mild hypocapnia if crashing, normothermia, osmotherapy and maintenance of CPP. Reducing MAP may compromise cerebral perfusion. Hypotonic fluid and hypercapnia can worsen intracranial hypertension. Sedation interruption is unsafe during uncontrolled ICP elevation.

Reference: Brain Trauma Foundation severe TBI guidance; NACCS neurocritical care guidance