ReviewFrontiers in neurology2020
Escalate and De-Escalate Therapies for Intracranial Pressure Control in Traumatic Brain Injury.
Review in Frontiers in neurology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 16 citations in OpenAlex.
- Association Between Pain, Agitation, and Intracranial Pressure with Cerebral Near-Infrared Spectroscopy in Critically Ill Children: A Prospective Pilot Study.Journal of clinical medicine · 2026Article
- Efficacy of Step-down Infusion Method of a Novel Barbiturate Therapy for Severe Subarachnoid Hemorrhage with Intracerebral Hematoma.Neurologia medico-chirurgica · 2025Article
- The use of tier three therapies in acute brain injured patients: Insight from the Extubation strategies in Neuro-Intensive care unit patients and associations with Outcomes observational study.European journal of anaesthesiology and intensive care · 2024Article
- Article
- The intracranial compartmental syndrome: a proposed model for acute brain injury monitoring and management.Critical care (London, England) · 2023Review
- Intergenerational Perioperative Neurocognitive Disorder in Young Adult Male Rats with Traumatic Brain Injury.Anesthesiology · 2023Article
- Adult Critical Care Electroencephalography Monitoring for Seizures: A Narrative Review.Frontiers in neurology · 2022Review
- Efficacy of a Novel Prophylactic Barbiturate Therapy for Severe Traumatic Brain Injuries: Step-down Infusion of a Barbiturate with Normothermia.Neurologia medico-chirurgica · 2021Article
- Novel Synthetic and Natural Therapies for Traumatic Brain Injury.Current neuropharmacology · 2021Review
- Effect of Mild Hypothermia after Craniotomy on the Function of Related Organs in Patients with Traumatic Brain Injury.Emergency medicine international · 2021Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Severe traumatic brain injury (TBI) is frequently associated with an elevation of intracranial pressure (ICP), followed by cerebral perfusion pressure (CPP) reduction. Invasive monitoring of ICP is recommended to guide a step-by-step "staircase approach" which aims to normalize ICP values and reduce the risks of secondary damage. However, if such monitoring is not available clinical examination and radiological criteria should be used. A major concern is how to taper the therapies employed for ICP control. The aim of this manuscript is to review the criteria for escalating and withdrawing therapies in TBI patients. Each step of the staircase approach carries a risk of adverse effects related to the duration of treatment. Tapering of barbiturates should start once ICP control has been achieved for at least 24 h, although a period of 2-12 days is often required. Administration of hyperosmolar fluids should be avoided if ICP is normal. Sedation should be reduced after at least 24 h of controlled ICP to allow neurological examination. Removal of invasive ICP monitoring is suggested after 72 h of normal ICP. For patients who have undergone surgical decompression, cranioplasty represents the final step, and an earlier cranioplasty (15-90 days after decompression) seems to reduce the rate of infection, seizures, and hydrocephalus.
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