DECREASING CEREBRAL

EDEMA

REDUCING CSF AND

INTRACRANIAL BLOOD
VOLUME

CONTROLLING FEVER
 Methods for Decreasing
Cerebral Edema
1. Osmotic Diuretics
(Mannitol)
May be given to
dehydrate the brain
tissue and reduce
cerebral edema.
They act by drawing
water across intact
membranes, thereby
reducing the volume of
brain and extracellular
fluid.
 To monitor urinary
output and to
manage the resulting
diuresis. An
indwelling urinary
catheter is usually
inserted. When a patient is
receiving osmotic
diuretics, serum
osmolality should be
determined to assess
hydration status.
2. Corticosteroids 3. Fluid Restriction
( Dexamethasone) Limiting overall fluid
Help reduce the edema intake leads to
surrounding brain dehydration and
tumors when a brain hemoconcentration,
tumor is the cause of drawing fluid across
increased ICP. the osmotic gradient
and decreasing
cerebral edema.
 It has been hypothesized that lowering
body temperature will decrease cerebral edema,
reduce the oxygen and metabolic requirements
of the brain, and protect the brain from
continued ischemia
If body metabolism can be reduced by
lowering body temperature, the collateral
circulation in the brain may be able to provide
an adequate blood supply to the brain. The
effect of hypothermia on ICP requires more
study but as yet induced hypothermia has not
been proven to be beneficial in the brain-
injured patient.
 REDUCING CSF AND
INTRACRANIAL BLOOD VOLUME
CSF drainage is frequently performed because
the removal of CSF with a ventriculostomy drain
may dramatically reduce ICP and restore
cerebral perfusion pressure.

Caution: Should be used in draining CSF

because excessive drainage may result in
collapse of the ventricles.
The reduction in the PaCO2 may result:
hypoxia
ischemia
an increase in cerebral lactate levels

Maintaining the PaCO2 at 30 to 35 mm Hg

may prove beneficial.
CONTROLLING FEVER
Preventing a temperature elevation is critical
because fever increases cerebral metabolism
and the rate at which cerebral edema
forms.
Strategies to reduce temperature:
administration of antipyretic medications, as
prescribed
use of a cooling blanket
The patients temperature is monitored closely,
and the patient is observed for shivering, which
should be avoided because it increases ICP.