This protocol applies to patients with acute ischemic stroke who develop cerebral edema or elevated intracranial pressure — a serious complication requiring prompt, targeted intervention to reduce secondary neurological injury.
The primary objective is reduction of elevated intracranial pressure and cerebral edema. Achieving these goals is central to limiting further neurological deterioration in the acute setting.
Initial management centers on intravenous hypertonic fluid therapy. The structured protocol specifies the agent options and the full clinical decision framework — including when and how to apply each approach.
References
DOI: 10.1007/s12028-020-00959-7
We suggest using either hypertonic sodium solutions or mannitol for the initial management of ICP or cerebral edema in patients with acute ischemic stroke (conditional recommendation, low-quality evidence).
While the overall quality of evidence in this area is low, the panel felt there was enough consistency across published studies to suggest that both HTS and mannitol are effective in reducing ICP elevations and cerebral edema in AIS.
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