J Korean Med Assoc.  2023 May;66(5):278-283. 10.5124/jkma.2023.66.5.278.

Basic principle in the management of brain edema and elevated intracranial pressure

• Ko SB

• KMID: 2542677
• DOI: http://doi.org/10.5124/jkma.2023.66.5.278

Abstract

Background
Brain edema is a well-recognized pathophysiological secondary change after primary brain injury. The mechanism of brain edema may differ based on the types of brain edema. However, numerous ion channels are involved in its development and are therefore currently a hot target for anti-edema therapy. Here, this paper reviews the clinically important differences among the types of brain edema and a step-wise management strategy for brain edema and elevated intracranial pressure (ICP).
Current Concepts
Brain edema can be classified as cytotoxic, ionic, vasogenic, and interstitial edema. Although the underlying mechanisms may differ among the various types of brain edema, multiple ion channels and the integrity of tight junctions are associated with the development of brain edema. If brain edema aggravates, the intracranial volume expands and leads to an elevation of ICP. A basic principle in the management of ICP includes proper positioning, screening for a need for extraventricular drainage, proper sedation, transient hyperventilation, assessing the intracranial water status with the serum sodium level, optimization of cerebral perfusion pressure, hyperosmolar therapy, targeted temperature management, and induction of a pharmacological coma with sedatives.
Discussion and Conclusion
Stepwise treatment strategies are recommended in the management of patients with ICP crisis. Based on the principle, detailed management plans need to be adjusted based on the status of an individual patient.

Keyword

Brain edema; Intracranial pressure; Brain injury; Therapeutics; 뇌부종; 두개내압; 뇌손상; 치료