Increased intracranial pressure Treatment principles for patients with increased ICP include Rapid-sequence orotracheal intubation Mechanical ventilation Monitoring of ICP and CPP Sedation as needed Maintaining euvolemia and serum osmolality of 295 to 320 mOsm / kg (295 to 320 mmol / kg) For intractable increased ICP, possibly cerebrospinal fluid (CSF) drainage, temporary hyperventilation, decompressive craniotomy, or pentobarbital coma Rapid-sequence oral intubation (using paralysis) is used rather than awake nasotracheal intubation if patients with TBI require airway support or mechanical ventilation.