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Verticalization for Refractory Intracranial Hypertension: A Case Series

By Currents Editor posted 10-21-2021 08:30


Verticalization for Refractory Intracranial Hypertension: A Case Series

Neurocritical Care (08/17/21) DOI: 10.1007/s12028-021-01323-z

Lachance, Brittany Bolduc; Chang, WanTsu; Motta, Melissa; et al.


Researchers present a retrospective review of six cases of refractory intracranial hypertension in a tertiary care center. The authors also report a novel intervention of verticalization for treating intracranial hypertension refractory to aggressive medical treatment. The patients — five of whom were admitted with subarachnoid hemorrhage and one with intracerebral hemorrhage — were treated with a standard-of-care algorithm for lowering intracranial pressure (ICP) but maintained an ICP >20 mmHg. The patients, all of whom had ICP monitoring by external ventricular drain, were then treated with verticalization for at least 24 hours. The median opening pressure was 30 mmHg. After verticalization, all six patients had a lower ICP — with a meaningful reduction in in the median ICP (12 vs 8 mmHg), the number of ICP spikes (12 vs. 2), and the percentage of ICP values greater than 20 mmHg (50% vs. 8.3%). The total number of medical interventions declined after verticalization (79 vs. 41), and the total therapy intensity level score was lower as well. The most frequently reported adverse effects were pressure wounds and asymptomatic bradycardia. The findings, the researchers report, highlight the efficacy of verticalization as a noninvasive intervention for lowering ICP in intracranial hypertension that is refractory to aggressive standard management.


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