Which intervention is mentioned for decreasing intracranial pressure in stroke care?

• A. Hyperventilation
• B. PEEP
• C. High tidal volume ventilation
• D. Aggressive fluid resuscitation

Answer: (A)

Lowering intracranial pressure in acute stroke is achieved by reducing cerebral blood volume, which can be done rapidly by lowering arterial CO2 levels. Hyperventilation lowers PaCO2, prompting cerebral arteriolar vasoconstriction. That constriction reduces blood flow to the brain and decreases intracranial pressure, making it a fast-acting, temporizing measure during periods of ICP elevation or risk of herniation. It’s used with close monitoring because prolonged hypocapnia can compromise cerebral perfusion and lead to ischemia.

The other approaches don’t fit this purpose. Positive end-expiratory pressure raises intrathoracic pressure and can hinder venous drainage from the brain, often increasing ICP rather than reducing it. Aggressive fluid resuscitation can worsen cerebral edema and raise intracranial pressure. High tidal volume ventilation isn’t a targeted strategy for lowering ICP and carries risks like lung injury, so it isn’t used specifically for this goal.