The decision to use a VC or a parenchymal cath- eter device should be based on whether there is a need to drain CSF to treat hydrocephalus or elevated ICP. Because of limited data regarding indications for monitor- ing and treatment of ICP in ICH, management principles for elevated ICP are usually generalized from those for traumatic brain injury, in which current guidelines recommend place- ment of an ICP monitor in patients with a GCS score of 3 to 8 and maintenance of an ICP <20 mmHg and a CPP of 50 to 70 mmHg, depending on the status of cerebral autoregula- Data from small, retrospectively analyzed cohorts of ICH patients suggest that rising ICP and declining CPP are associated with mortality.184,195,196 In 1 study of multimodality monitoring in 18 ICH patients, CPP <70 to 80 mmHg was associated with brain tissue hypoxia and poor outcome.195 Thus, ICP monitoring and subsequent treatment might be considered in ICH patients with a GCS score of 8 that is presumed related to hematoma mass effect, those with clinical evidence of transtentorial herniation, or those with significant IVH or hydrocephalus. Methods of treating elevated ICP are generally borrowed from traumatic brain injury guidelines as well. Basic princi- ples include elevation of the head of the bed to 30 , the use of mild sedation, and avoidance of collar-endotracheal tube ties that might constrict cervical veins.197 Mannitol or hypertonic saline may be used to treat acute ICP elevations, and hypertonic saline may be more effective.198 In patients with CSF outflow obstruction caused by hydrocephalus or a trapped ventricle, CSF drainage should be considered. Hematoma evacuation and decompressive craniectomy (DC) are options for treating ele- vated ICP and are discussed in the section on SurgicalTreatment of ICH. Salvage therapies might include barbiturate coma or mild hypothermia. 