The use of systemic dehydration for the management of raised intracranial pressure is inappropriate, since reductions in mean arterial pressure trigger autoregulatory cerebral vasodilatation and increase cerebral blood volume and intracranial pressure ( Fig 1(b)). In general, current practice is to aim for euvolemia and maintain a cerebral perfusion pressure that ensures adequate cerebral perfusion. In many instances mean arterial pressure may need to be increased above normal levels to maintain cerebral perfusion pressure and cerebral blood flow in the face of intracranial hypertension, vasospasm, or regional vascular occlusion.
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