Which of the following would indicate a late sign of increased ICP in this child?

1. Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: A brief overview. J Head Trauma Rehabil. 2006;21:375–8. [PubMed] [Google Scholar]

2. Rutigliano D, Egnor MR, Priebe CJ, McCormack JE, Strong N, Scriven RJ, et al. Decompressive craniectomy in pediatric patients with traumatic brain injury with intractable elevated intracranial pressure. J Pediatr Surg. 2006;41:83–7. [PubMed] [Google Scholar]

3. McLaughlin MR, Marion DW. Cerebral blood flow and vasoresponsivity within and around cerebral contusions. J Neurosurg. 1996;85:871–6. [PubMed] [Google Scholar]

4. Marmarou A. Increased intracranial pressure in head injury and influence of blood volume. J Neurotrauma. 1992;9(Suppl 1):S327–32. [PubMed] [Google Scholar]

5. Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012;367:2471–81. [PMC free article] [PubMed] [Google Scholar]

6. Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents – Second edition. Pediatr Crit Care Med. 2012;13(Suppl 1):S1–82. [PubMed] [Google Scholar]

8. Marmarou A, Fatouros PP, Barzó P, Portella G, Yoshihara M, Tsuji O, et al. Contribution of edema and cerebral blood volume to traumatic brain swelling in head-injured patients. J Neurosurg. 2000;93:183–93. [PubMed] [Google Scholar]

9. Marmarou A. Pathophysiology of traumatic brain edema: Current concepts. Acta Neurochir Suppl. 2003;86:7–10. [PubMed] [Google Scholar]

10. Unterberg AW, Stover J, Kress B, Kiening KL. Edema and brain trauma. Neuroscience. 2004;129:1021–9. [PubMed] [Google Scholar]

11. Marmarou A, Signoretti S, Aygok G, Fatouros P, Portella G. Traumatic brain edema in diffuse and focal injury: Cellular or vasogenic? Acta Neurochir Suppl. 2006;96:24–9. [PubMed] [Google Scholar]

12. Marmarou A, Signoretti S, Fatouros PP, Portella G, Aygok GA, Bullock MR. Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries. J Neurosurg. 2006;104:720–30. [PubMed] [Google Scholar]

13. Bruzzone P, Dionigi R, Bellinzona G, Imberti R, Stocchetti N. Effects of cerebral perfusion pressure on brain tissue PO2 in patients with severe head injury. Acta Neurochir Suppl. 1998;71:111–3. [PubMed] [Google Scholar]

14. Bouma GJ, Muizelaar JP, Fatouros P. Pathogenesis of traumatic brain swelling: Role of cerebral blood volume. Acta Neurochir Suppl. 1998;71:272–5. [PubMed] [Google Scholar]

15. Tameem AB, Krovvidi HR. Cerebral physiology. Contin Educ Anaesth Crit Care Pain. 2013;13:113–8. [Google Scholar]

16. Reivich M. Arterial pco2 and cerebral hemodynamics. Am J Physiol. 1964;206:25–35. [PubMed] [Google Scholar]

17. Biros MH, Heegaard W. Prehospital and resuscitative care of the head-injured patient. Curr Opin Crit Care. 2001;7:444–9. [PubMed] [Google Scholar]

18. Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care, AANS/CNS, Bratton SL, Chestnut RM, et al. Guidelines for the management of severe traumatic brain injury. VIII. Intracranial pressure thresholds. J Neurotrauma. 2007;24(Suppl 1):S55–8. [PubMed] [Google Scholar]

19. Cruz J, Nakayama P, Imamura JH, Rosenfeld KG, de Souza HS, Giorgetti GV. Cerebral extraction of oxygen and intracranial hypertension in severe, acute, pediatric brain trauma: Preliminary novel management strategies. Neurosurgery. 2002;50:774–9. [PubMed] [Google Scholar]

20. Adelson PD, Ragheb J, Kanev P, Brockmeyer D, Beers SR, Brown SD, et al. Phase II clinical trial of moderate hypothermia after severe traumatic brain injury in children. Neurosurgery. 2005;56:740–54. [PubMed] [Google Scholar]

21. Chambers IR, Treadwell L, Mendelow AD. Determination of threshold levels of cerebral perfusion pressure and intracranial pressure in severe head injury by using receiver-operating characteristic curves: An observational study in 291 patients. J Neurosurg. 2001;94:412–6. [PubMed] [Google Scholar]

22. Jagannathan J, Okonkwo DO, Yeoh HK, Dumont AS, Saulle D, Haizlip J, et al. Long-term outcomes and prognostic factors in pediatric patients with severe traumatic brain injury and elevated intracranial pressure. J Neurosurg Pediatr. 2008;2:240–9. [PubMed] [Google Scholar]

23. Michaud LJ, Rivara FP, Grady MS, Reay DT. Predictors of survival and severity of disability after severe brain injury in children. Neurosurgery. 1992;31:254–64. [PubMed] [Google Scholar]

24. Esparza J, M-Portillo J, Sarabia M, Yuste JA, Roger R, Lamas E. Outcome in children with severe head injuries. Childs Nerv Syst. 1985;1:109–14. [PubMed] [Google Scholar]

25. Rosenwasser RH, Kleiner LI, Krzeminski JP, Buchheit WA. Intracranial pressure monitoring in the posterior fossa: A preliminary report. J Neurosurg. 1989;71:503–5. [PubMed] [Google Scholar]

26. Wolfla CE, Luerssen TG, Bowman RM. Regional brain tissue pressure gradients created by expanding extradural temporal mass lesion. J Neurosurg. 1997;86:505–10. [PubMed] [Google Scholar]

27. Zhong J, Dujovny M, Park HK, Perez E, Perlin AR, Diaz FG. Advances in ICP monitoring techniques. Neurol Res. 2003;25:339–50. [PubMed] [Google Scholar]

28. Steiner LA, Andrews PJ. Monitoring the injured brain: ICP and CBF. Br J Anaesth. 2006;97:26–38. [PubMed] [Google Scholar]

29. Birch AA, Eynon CA, Schley D. Erroneous intracranial pressure measurements from simultaneous pressure monitoring and ventricular drainage catheters. Neurocrit Care. 2006;5:51–4. [PubMed] [Google Scholar]

30. Mayhall CG, Archer NH, Lamb VA, Spadora AC, Baggett JW, Ward JD, et al. Ventriculostomy-related infections. A prospective epidemiologic study. N Engl J Med. 1984;310:553–9. [PubMed] [Google Scholar]

31. Gopinath SP, Robertson CS, Contant CF, Narayan RK, Grossman RG. Clinical evaluation of a miniature strain-gauge transducer for monitoring intracranial pressure. Neurosurgery. 1995;36:1137–40. [PubMed] [Google Scholar]

32. Koskinen LO, Olivecrona M. Clinical experience with the intraparenchymal intracranial pressure monitoring Codman MicroSensor system. Neurosurgery. 2005;56:693–8. [PubMed] [Google Scholar]

33. Martínez-Mañas RM, Santamarta D, de Campos JM, Ferrer E. Camino intracranial pressure monitor: Prospective study of accuracy and complications. J Neurol Neurosurg Psychiatry. 2000;69:82–6. [PMC free article] [PubMed] [Google Scholar]

34. Sahuquillo J, Poca MA, Arribas M, Garnacho A, Rubio E. Interhemispheric supratentorial intracranial pressure gradients in head-injured patients: Are they clinically important? J Neurosurg. 1999;90:16–26. [PubMed] [Google Scholar]

35. Gwer S, Sheward V, Birch A, Marchbanks R, Idro R, Newton CR, et al. The tympanic membrane displacement analyser for monitoring intracranial pressure in children. Childs Nerv Syst. 2013;29:927–33. [PMC free article] [PubMed] [Google Scholar]

36. Soldatos T, Chatzimichail K, Papathanasiou M, Gouliamos A. Optic nerve sonography: A new window for the non-invasive evaluation of intracranial pressure in brain injury. Emerg Med J. 2009;26:630–4. [PubMed] [Google Scholar]

37. Schmidt B, Czosnyka M, Raabe A, Yahya H, Schwarze JJ, Sackerer D, et al. Adaptive noninvasive assessment of intracranial pressure and cerebral autoregulation. Stroke. 2003;34:84–9. [PubMed] [Google Scholar]

38. Kirkness CJ, Mitchell PH, Burr RL, March KS, Newell DW. Intracranial pressure waveform analysis: Clinical and research implications. J Neurosci Nurs. 2000;32:271–7. [PubMed] [Google Scholar]

39. Morgalla MH, Stumm F, Hesse G. A computer-based method for continuous single pulse analysis of intracranial pressure waves. J Neurol Sci. 1999;168:90–5. [PubMed] [Google Scholar]

40. Lundberg N, Troupp H, Lorin H. Continuous recording of the ventricular-fluid pressure in patients with severe acute traumatic brain injury. A preliminary report. J Neurosurg. 1965;22:581–90. [PubMed] [Google Scholar]

41. Smith M. Monitoring intracranial pressure in traumatic brain injury. Anesth Analg. 2008;106:240–8. [PubMed] [Google Scholar]

42. Tasker RC. Head and spinal cord trauma. In: Nichols DG, editor. Rogers’ Textbook of Pediatric Intensive Care. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2008. pp. 887–911. [Google Scholar]

43. Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Prehospital airway management. Pediatr Crit Care Med. 2003;4(Chapter 3):S9–11. [PubMed] [Google Scholar]

44. Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Critical pathway for the treatment of established intracranial hypertension in pediatric traumatic brain injury. Pediatr Crit Care Med. 2003;4(Chapter 17):S65–7. [PubMed] [Google Scholar]

45. Unterberg AW, Kiening KL, Härtl R, Bardt T, Sarrafzadeh AS, Lanksch WR. Multimodal monitoring in patients with head injury: Evaluation of the effects of treatment on cerebral oxygenation. J Trauma. 1997;42:S32–7. [PubMed] [Google Scholar]

46. Juul N, Morris GF, Marshall SB, Marshall LF. Intracranial hypertension and cerebral perfusion pressure: Influence on neurological deterioration and outcome in severe head injury. The Executive Committee of the International Selfotel Trial. J Neurosurg. 2000;92:1–6. [PubMed] [Google Scholar]

47. Downard C, Hulka F, Mullins RJ, Piatt J, Chesnut R, Quint P, et al. Relationship of cerebral perfusion pressure and survival in pediatric brain-injured patients. J Trauma. 2000;49:654–8. [PubMed] [Google Scholar]

48. Elias-Jones AC, Punt JA, Turnbull AE, Jaspan T. Management and outcome of severe head injuries in the Trent region 1985-90. Arch Dis Child. 1992;67:1430–5. [PMC free article] [PubMed] [Google Scholar]

49. Feldman Z, Kanter MJ, Robertson CS, Contant CF, Hayes C, Sheinberg MA, et al. Effect of head elevation on intracranial pressure, cerebral perfusion pressure, and cerebral blood flow in head-injured patients. J Neurosurg. 1992;76:207–11. [PubMed] [Google Scholar]

50. Chesnut RM. Medical management of severe head injury: Present and future. New Horiz. 1995;3:581–93. [PubMed] [Google Scholar]

51. Kerr EM, Marion D, Sereika MS, Weber BB, Orndoff AP, Henker R, et al. The effect of cerebrospinal fluid drainage on cerebral perfusion in traumatic brain injured adults. J Neurosurg Anesthesiol. 2000;12:324–33. [PubMed] [Google Scholar]

52. Shore PM, Thomas NJ, Clark RS, Adelson PD, Wisniewski SR, Janesko KL, et al. Continuous versus intermittent cerebrospinal fluid drainage after severe traumatic brain injury in children: Effect on biochemical markers. J Neurotrauma. 2004;21:1113–22. [PubMed] [Google Scholar]

53. Wise BL, Chater N. The value of hypertonic mannitol solution in decreasing brain mass and lowering cerebro-spinal-fluid pressure. J Neurosurg. 1962;19:1038–43. [PubMed] [Google Scholar]

54. Muizelaar JP, Wei EP, Kontos HA, Becker DP. Mannitol causes compensatory cerebral vasoconstriction and vasodilation in response to blood viscosity changes. J Neurosurg. 1983;59:822–8. [PubMed] [Google Scholar]

55. Muizelaar JP, Lutz HA, 3rd, Becker DP. Effect of mannitol on ICP and CBF and correlation with pressure autoregulation in severely head-injured patients. J Neurosurg. 1984;61:700–6. [PubMed] [Google Scholar]

56. Paczynski RP. Osmotherapy. Basic concepts and controversies. Crit Care Clin. 1997;13:105–29. [PubMed] [Google Scholar]

57. Nath F, Galbraith S. The effect of mannitol on cerebral white matter water content. J Neurosurg. 1986;65:41–3. [PubMed] [Google Scholar]

58. Allen CH, Ward JD. An evidence-based approach to management of increased intracranial pressure. Crit Care Clin. 1998;14:485–95. [PubMed] [Google Scholar]

59. Kaufmann AM, Cardoso ER. Aggravation of vasogenic cerebral edema by multiple-dose mannitol. J Neurosurg. 1992;77:584–9. [PubMed] [Google Scholar]

60. Khanna S, Davis D, Peterson B, Fisher B, Tung H, O’Quigley J, et al. Use of hypertonic saline in the treatment of severe refractory posttraumatic intracranial hypertension in pediatric traumatic brain injury. Crit Care Med. 2000;28:1144–51. [PubMed] [Google Scholar]

61. Peterson B, Khanna S, Fisher B, Marshall L. Prolonged hypernatremia controls elevated intracranial pressure in head-injured pediatric patients. Crit Care Med. 2000;28:1136–43. [PubMed] [Google Scholar]

62. Walsh JC, Zhuang J, Shackford SR. A comparison of hypertonic to isotonic fluid in the resuscitation of brain injury and hemorrhagic shock. J Surg Res. 1991;50:284–92. [PubMed] [Google Scholar]

63. Qureshi AI, Suarez JI. Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension. Crit Care Med. 2000;28:3301–13. [PubMed] [Google Scholar]

64. Nakayama S, Kramer GC, Carlsen RC, Holcroft JW. Infusion of very hypertonic saline to bled rats: Membrane potentials and fluid shifts. J Surg Res. 1985;38:180–6. [PubMed] [Google Scholar]

65. Arjamaa O, Karlqvist K, Kanervo A, Vainionpää V, Vuolteenaho O, Leppäluoto J. Plasma ANP during hypertonic NaCl infusion in man. Acta Physiol Scand. 1992;144:113–9. [PubMed] [Google Scholar]

66. Dominguez TE, Priestley MA, Huh JW. Caution should be exercised when maintaining a serum sodium level>160 meq/L. Crit Care Med. 2004;32:1438–9. [PubMed] [Google Scholar]

67. Muizelaar JP, Marmarou A, DeSalles AA, Ward JD, Zimmerman RS, Li Z, et al. Cerebral blood flow and metabolism in severely head-injured children. Part 1: Relationship with GCS score, outcome, ICP, and PVI. J Neurosurg. 1989;71:63–71. [PubMed] [Google Scholar]

68. Adelson PD, Clyde B, Kochanek PM, Wisniewski SR, Marion DW, Yonas H. Cerebrovascular response in infants and young children following severe traumatic brain injury: A preliminary report. Pediatr Neurosurg. 1997;26:200–7. [PubMed] [Google Scholar]

69. Skippen P, Seear M, Poskitt K, Kestle J, Cochrane D, Annich G, et al. Effect of hyperventilation on regional cerebral blood flow in head-injured children. Crit Care Med. 1997;25:1402–9. [PubMed] [Google Scholar]

70. Curry R, Hollingworth W, Ellenbogen RG, Vavilala MS. Incidence of hypo- and hypercarbia in severe traumatic brain injury before and after 2003 pediatric guidelines. Pediatr Crit Care Med. 2008;9:141–6. [PubMed] [Google Scholar]

71. Morris KP, Forsyth RJ, Parslow RC, Tasker RC, Hawley CA, et al. UK Paediatric Traumatic Brain Injury Study Group. Intracranial pressure complicating severe traumatic brain injury in children: Monitoring and management. Intensive Care Med. 2006;32:1606–12. [PubMed] [Google Scholar]

72. Kassell NF, Hitchon PW, Gerk MK, Sokoll MD, Hill TR. Alterations in cerebral blood flow, oxygen metabolism, and electrical activity produced by high dose sodium thiopental. Neurosurgery. 1980;7:598–603. [PubMed] [Google Scholar]

73. Cormio M, Gopinath SP, Valadka A, Robertson CS. Cerebral hemodynamic effects of pentobarbital coma in head-injured patients. J Neurotrauma. 1999;16:927–36. [PubMed] [Google Scholar]

74. Pittman T, Bucholz R, Williams D. Efficacy of barbiturates in the treatment of resistant intracranial hypertension in severely head-injured children. Pediatr Neurosci. 1989;15:13–7. [PubMed] [Google Scholar]

75. Goodman JC, Valadka AB, Gopinath SP, Cormio M, Robertson CS. Lactate and excitatory amino acids measured by microdialysis are decreased by pentobarbital coma in head-injured patients. J Neurotrauma. 1996;13:549–56. [PubMed] [Google Scholar]

76. Ward JD, Becker DP, Miller JD, Choi SC, Marmarou A, Wood C, et al. Failure of prophylactic barbiturate coma in the treatment of severe head injury. J Neurosurg. 1985;62:383–8. [PubMed] [Google Scholar]

77. Cruz J. Adverse effects of pentobarbital on cerebral venous oxygenation of comatose patients with acute traumatic brain swelling: Relationship to outcome. J Neurosurg. 1996;85:758–61. [PubMed] [Google Scholar]

78. Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E, et al. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst. 2001;17:154–62. [PubMed] [Google Scholar]

79. Figaji AA, Fieggen AG, Peter JC. Early decompressive craniotomy in children with severe traumatic brain injury. Childs Nerv Syst. 2003;19:666–73. [PubMed] [Google Scholar]

80. Jagannathan J, Okonkwo DO, Dumont AS, Ahmed H, Bahari A, Prevedello DM, et al. Outcome following decompressive craniectomy in children with severe traumatic brain injury: A 10-year single-center experience with long-term follow up. J Neurosurg. 2007;106:268–75. [PubMed] [Google Scholar]

81. Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D’Urso P, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364:1493–502. [PubMed] [Google Scholar]

82. Polin RS, Shaffrey ME, Bogaev CA, Tisdale N, Germanson T, Bocchicchio B, et al. Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosurgery. 1997;41:84–92. [PubMed] [Google Scholar]

83. Weintraub D, Williams BJ, Jane J., Jr Decompressive craniectomy in pediatric traumatic brain injury: A review of the literature. NeuroRehabilitation. 2012;30:219–23. [PubMed] [Google Scholar]

84. Kan P, Amini A, Hansen K, White GL, Jr, Brockmeyer DL, Walker ML, et al. Outcomes after decompressive craniectomy for severe traumatic brain injury in children. J Neurosurg. 2006;105(5 Suppl):337–42. [PubMed] [Google Scholar]

85. Tokutomi T, Morimoto K, Miyagi T, Yamaguchi S, Ishikawa K, Shigemori M. Optimal temperature for the management of severe traumatic brain injury: Effect of hypothermia on intracranial pressure, systemic and intracranial hemodynamics, and metabolism. Neurosurgery. 2003;52:102–11. [PubMed] [Google Scholar]

86. Peterson K, Carson S, Carney N. Hypothermia treatment for traumatic brain injury: A systematic review and meta-analysis. J Neurotrauma. 2008;25:62–71. [PubMed] [Google Scholar]

87. Adelson PD, Wisniewski SR, Beca J, Brown SD, Bell M, Muizelaar JP, et al. Comparison of hypothermia and normothermia after severe traumatic brain injury in children (Cool Kids): A phase 3, randomised controlled trial. Lancet Neurol. 2013;12:546–53. [PubMed] [Google Scholar]

88. Hutchison JS, Ward RE, Lacroix J, Hébert PC, Barnes MA, Bohn DJ, et al. Hypothermia therapy after traumatic brain injury in children. N Engl J Med. 2008;358:2447–56. [PubMed] [Google Scholar]

89. Levy DI, Rekate HL, Cherny WB, Manwaring K, Moss SD, Baldwin HZ. Controlled lumbar drainage in pediatric head injury. J Neurosurg. 1995;83:453–60. [PubMed] [Google Scholar]

90. Mazzola CA, Adelson PD. Critical care management of head trauma in children. Crit Care Med. 2002;30:S393–401. [PubMed] [Google Scholar]

91. Young B, Rapp RP, Norton JA, Haack D, Tibbs PA, Bean JR. Failure of prophylactically administered phenytoin to prevent late posttraumatic seizures. J Neurosurg. 1983;58:236–41. [PubMed] [Google Scholar]

92. Temkin NR, Dikmen SS, Wilensky AJ, Keihm J, Chabal S, Winn HR. A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med. 1990;323:497–502. [PubMed] [Google Scholar]

Which of the following is a late sign of ICP?

Which of the following is a late sign of increased ICP in this child?

Which signs and symptoms indicate an increase in ICP in a child?

Which of the following is a sign of increasing ICP?