Pentobarbital sodium coma for refractory intracranial hypertension.

Refractory intracranial hypertension (RICH) is defined as intracranial pressures that exceed 25 mm Hg for 30 minutes, 30 mm Hg for 15 minutes, or 40 mm Hg for 1 minute. RICH occurs in approximately 15% of patients with traumatic brain injury. If it is not aggressively treated, RICH can result in cerebral herniation and death. Pentobarbital sodium coma is a second-tier treatment that can be used to treat RICH. Understanding the principal mechanics of this therapy is key to the successful management of RICH and quality patient care.