An elevation of intracranial pressure (ICP) is a common complication in patients with head injury, neoplasia, cerebral vascular accidents, infections, or metabolic disorders. ICP is monitored in the pediatric intensive care unit (ICU) when one or more of the indications listed in Table 444.1 is present.

Normal ICP in children is 15 mm Hg or less. However, the goal in controlling ICP is not necessarily to preserve this ideal number but to preserve cerebral perfusion pressure (CPP). CPP is the difference between the mean arterial pressure (MAP) and the ICP: CPP = MAP – ICP. In a normal child, a CPP of 40 mm Hg or more is sufficient to maintain normal blood flow and the appropriate delivery of nutrients.