{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T12:13:36Z","timestamp":1773058416590,"version":"3.50.1"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dimens Crit Care Nurs"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:p>Dangerous, sustained elevation in intracranial pressure (ICP) is a risk for any patient following severe brain injury. Intracranial pressure elevations that do not respond to initial management are considered refractory to treatment, or rICP. Patients are at significant risk of secondary brain injury and permanent loss of function resulting from rICP. Both nonpharmacologic and pharmacologic interventions are utilized to intervene when a patient experiences either elevation in ICP or rICP. In part 1 of this 2-part series, pharmacologic interventions are discussed. Opioids, sedatives, osmotic diuretics, hypertonic saline solutions, and barbiturates are drug classes that may be used in an attempt to normalize ICP and prevent secondary injury. Nursing care of these patients includes collaboration with an interprofessional team and is directed toward patient and family comfort. The utilization of an evidence-based guideline for the management of rICP is strongly encouraged to improve patient outcomes.<\/jats:p>","DOI":"10.1097\/dcc.0000000000000293","type":"journal-article","created":{"date-parts":[[2018,3,29]],"date-time":"2018-03-29T03:28:01Z","timestamp":1522294081000},"page":"120-129","source":"Crossref","is-referenced-by-count":10,"title":["Management of Intracranial Pressure: Part I"],"prefix":"10.1097","volume":"37","author":[{"given":"Tara L.","family":"Sacco","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha A.","family":"Delibert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"issue":"4","key":"bib1-20230908","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.aorn.2009.12.025","article-title":"Caring for the perioperative patient with increased intracranial pressure","volume":"91","year":"2010","journal-title":"AORN J"},{"issue":"5","key":"bib2-20230908","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1097\/00003465-200409000-00002","article-title":"Management of increased intracranial pressure: a primer for the non-neuro critical care nurse","volume":"23","year":"2004","journal-title":"Dimens Crit Care Nurs"},{"issue":"2","key":"bib3-20230908","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1097\/00044067-200504000-00012","article-title":"Management of increased intracranial pressure in the critically ill child with an acute neurological injury","volume":"16","year":"2005","journal-title":"AACN Clin Issues"},{"key":"bib4-20230908","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1097\/00075198-200312000-00007","article-title":"Traumatic brain injury","volume":"9","year":"2003","journal-title":"Curr Opin Crit Care"},{"issue":"5","key":"bib5-20230908","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1097\/JNN.0b013e3181ecafd4","article-title":"Effect of body position on cerebral oxygenation and pathophysiologic parameters in patients with acute neurological conditions","volume":"42","year":"2010","journal-title":"J Neurosci Nurs"},{"issue":"4","key":"bib6-20230908","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1097\/00044067-200510000-00007","article-title":"Preventing secondary brain injury: targeting technology","volume":"16","year":"2005","journal-title":"AACN Clin Issues"},{"key":"bib7-20230908","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.ccell.2009.07.009","article-title":"Current and evolving management of traumatic brain injury","volume":"21","year":"2009","journal-title":"Crit Care Nurs Clin N Am"},{"issue":"2","key":"bib8-20230908","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1097\/00044067-200504000-00011","article-title":"Hyperosmolar therapy in the treatment of severe head injury in children: mannitol and hypertonic saline","volume":"16","year":"2005","journal-title":"AACN Clin Issues"},{"issue":"4","key":"bib9-20230908","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1097\/00044067-200510000-00009","article-title":"Refractory increased intracranial pressure in severe traumatic brain injury. 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