Increased Intracranial Pressure

Raised intracranial pressure (ICP) is not simply a high monitor reading. It is a threat to cerebral perfusion and can progress to brain herniation. In severe adult traumatic brain injury (TBI), sustained ICP above 22 mm Hg is treated and the recommended CPP target is 60–70 mm Hg; however, acute herniation can occur independently of a sustained threshold and demands immediate action. The practical sequence is: recognize a change from baseline, protect oxygenation and perfusion, activate the rapid response team or emergency response, immediately notify the treating physician/NP and neurosurgical team, support ordered ICP-lowering measures, and reassess after each intervention. A patient who becomes increasingly drowsy, vomits repeatedly, develops a new pupil asymmetry, or shows abnormal posturing has a neurological emergency even if the last scheduled assessment and last ICP value were reassuring.