Which of the following is a second tier intervention for elevated ICP?

Mannitol 20% administration is considered a second tier intervention for elevated intracranial pressure (ICP) because it serves as an osmotic diuretic that helps to reduce cerebral edema. When ICP is elevated, it can threaten brain function and circulation, and mannitol works by drawing water out of the brain tissue and into the vascular space, thereby decreasing brain volume and lowering ICP.

This intervention is typically employed after initial treatments have been administered or when first-tier options, such as elevating the head of the bed or maintaining oxygenation and blood pressure, are not sufficient to control ICP. Mannitol's effect is rapid, making it particularly valuable in acute settings.

It is important to differentiate this from other interventions: hyperventilation can cause cerebral vasoconstriction but is usually considered more of an emergent measure rather than a standard second-tier intervention. Corticosteroid therapy mainly serves to reduce inflammation rather than directly lowering ICP, thus it is not classified under immediate ICP-reducing measures. Fluid resuscitation does not target cerebral edema specifically and can potentially exacerbate ICP if not managed carefully. Therefore, the administration of mannitol is a well-recognized and effective second-tier intervention for managing elevated ICP.