Severe Pediatric Traumatic Brain Injury (TBI), PICU — Medications — Clinical Pathway: Emergency, ICU and Inpatient

Traumatic Brain Injury (TBI) Clinical Pathway — Emergency Department and ICU

Medications to Treat Elevated ICP

Use 3% hypertonic saline if sedation and/or analgesia do not improve ICP. There are no level I-III recommendations in the 2019 Guidelines for severe pediatric TBI patients for the administration of mannitol for elevated ICP.

Medication Bolus Dose Infusion Dose Monitoring
3% Hypertonic Saline
  • 5 mL/kg (Max: 5 mL/kg
    or 500 mL/dose)
  • There is no limit on the number of boluses that may be given
  • 0.1 mL/kg/hr
  • Titrate to effect to max dose 1 mL/kg/hr
  • Maintain serum Osm
    < 320 mOsm/L
  • Maintain euvolemia
  • Monitor electrolytes, renal function, urine output

3% hypertonic saline is available in the PICU Pyxis with a “STAT” order.
Guidelines for Use of Hypertonic Saline in the PICU for Ordering Guidance Job Aid

Mannitol may be used as a second line and is available in the code cart.