University Hospital of Wales Paediatric Intensive Care Unit Guideline Printed on Wed 23-jul-08
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Last updated August 17, 2017 10:37 AM

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Head Injury

ICP and Cerebral perfusion pressure

Keep ICP < 20 mmHg

Maintain CPP:

CPP > 45-60 mmHg, Age < 10 yrs

CPP > 50-70 mmHg, Age > 10 yrs


Indications of ICP monitoring: These are suggestions only

Severe TBI GCS < 8 with abnormal admission head CT (haematoma, contusion, cerebral oedema and/or compressed brain cisterns).

Severe TBI GCS < 8 with normal admission head CT if two of the following features

Maintenance of Normal CPP

Cerebral perfusion pressure = Mean Arterial Pressure - ICP


Give volume if low CVP or clinically indicated
Start on noradrenaline infusion


Algorithm for maintaining CPP


Raised ICP

Is there an easily correctable or transient cause?


These should be excluded and corrected before proceeding with further treatment.

Emergency Management of Increased ICP


This is intended as a guide only. In some cases, it may be appropriate to tolerate higher ICP and maintain appropriate CPP rather than starting on thiopentone.

Algorithm for emergency management raised ICP


General Managment


Fluid Management





The Use of Hypothermia for TBI should not be adopted outside a clinical trial



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Dr Rim Alsamsam January 2016, to be reviewed January 2019.