Which procedure is contraindicated in a patient with increased ICP?

A lumbar puncture is contraindicated in patients with increased intracranial pressure (ICP) because this procedure can lead to a rapid decrease in cerebrospinal fluid (CSF) pressure, which may cause a shift in intracranial contents. This shift can potentially lead to brain herniation, a serious and life-threatening complication. Elevated ICP often indicates that there may be an underlying pathology, such as a mass or swelling in the brain, and performing a lumbar puncture in these circumstances can exacerbate the condition.

Maintaining the midline position of the head of the bed is a common practice for managing increased ICP, as this position helps promote venous drainage from the brain and can potentially lower ICP. Hyperosmotic diuretics, such as mannitol, are often utilized to draw fluid out of the brain and reduce edema, thereby lowering ICP. Barbiturate medications may be prescribed to help calm the brain and decrease metabolic demand, further aiding in the management of elevated ICP. However, a lumbar puncture poses a significant risk that outweighs any potential benefits in this scenario.