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. Corticosteroids should not be used, because they are not effective in ICH and increase complications.199 Small case series have described the use of brain tissue oxygen and cerebral microdialysis monitoring in patients with Because of the small numbers of patients and limited data, no recommendation can be made regarding the use of these technologies at this time. ICP Monitoring and Treatment: Recommendations Ventricular drainage as treatment for hydrocephalus is reasonable, especially in patients with decreased level of consciousness (Class IIa; Level of Evidence B). (Revised from the previous guideline) Patients with a GCS score of 8, those with clinical evidence of transtentorial herniation, or those with significant IVH or hydrocephalus might be consid- ered for ICP monitoring and treatment. A CPP of 50 to 70 mmHg may be reasonable to maintain depend- ing on the status of cerebral autoregulation (Class IIb; Level of Evidence C). (Unchanged from the previ- ous guideline) Corticosteroids should not be administered for treat- ment of elevated ICP in ICH (Class III; Level of Evidence B). (New recommendation) Intraventricular Hemorrhage IVH occurs in 45% of patients with spontaneous ICH and is an independent factor associated with poor outcome.190,202,203 Pooled analysis of 13 studies found IVH in association with ICH increased the risk of death from 20% without to 51% IVH can be primary, confined to the ventricles, or secondary, originating as an extension of an ICH. 