Algorithm for the management of increased ICP Algorithm for the management of increased ICP. aTreatment thresholds: ICP 20 to 29 mm Hg (2.7-3.9 kPa) for >15 minutes; ICP 30 to 39 mm Hg (4.0-5.2 kPa) for >2 minutes; ICP more than or equal to 40 mm Hg (≥5.3 kPa) for more than 1 minute. Note: Transient increases may occur following respiratory procedures (eg, suctioning, chest physiotherapy, bronchoscopy, and intubation). bHold if serum osmolality is more than 320 mOsm/kg (320 mmol/kg). cPartial pentobarbital loading dose (mg) = (30 mg/L – measured Cp) (1 L/kg × wt[kg]) (pentobarbital concentration in μmol/L must first be divided by 4.439 to convert to mg/L). (Cp, plasma concentration; EEG, electroencephalogram; ICP, intracranial pressure; ICU, intensive care unit; OR, operating room; PaCO2, partial pressure of arterial blood carbon dioxide.) (Reprinted with permission from Wood CG, Boucher BA. Acute Management of the Traumatic Brain Injury Patient. In: Richardson M, Chant C, Chessman KH, et al., eds. Pharmacotherapy Self-Assessment Program, 7th ed. Neurology and Psychiatry. Lenexa, KS: American College of Clinical Pharmacy, 2012:143-4.) Source: Acute Management of the Brain Injury Patient, Pharmacotherapy: A Pathophysiologic Approach, 10e Citation: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. Pharmacotherapy: A Pathophysiologic Approach, 10e; 2017 Available at: https://accesspharmacy.mhmedical.com/DownloadImage.aspx?image=/data/Books/1861/dipipharm10_ch58_f003.png&sec=134127835&BookID=1861&ChapterSecID=134127799&imagename= Accessed: October 11, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved