Until such monitoring is readily accessible, it is probably prudent to maintain vital signs within normal ranges. Hyperventilation therapy may be necessary for brief periods when there is acute neurologic deterioration, or for longer periods if there is intracranial hypertension refractory to sedation, paralysis, CSF drainage, and osmotic diuretics. Hyperventilation causes constriction of the blood vessels in the brain, reducing blood flow and thereby reducing intracranial pressure. However, injured brain may already be ischemic, and reducing blood flow to these areas may actually worsen the injury. The use of glucocorticoids is not recommended for improving outcome or reducing intracranial pressure in patients with severe head injury.
Studies using other types of non-glucocorticoid steroids as cerebroprotective agents are ongoing.
Note that methylprednisolone is still indicated for use in patients with acute spinal cord injury. Mannitol is effective for control of raised intracranial pressure after severe head injury. Limited data suggest that intermittent boluses may be more effective than continuous infusion. The indications for the use of mannitol prior to ICP monitoring are signs of transtentorial herniation or progressive neurologic deterioration not attributable to systemic pathology. Hypovolemia should be avoided by fluid replacement.