Effect of head elevation on intracranial pressure, cerebral perfusion pressure, and cerebral blood flow in head-injured patients

1992 ◽  
Vol 10 (5) ◽  
pp. 656
Author(s):  
Mary L. Sparkes
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Intracranial Pressure ◽  
Cerebral Perfusion Pressure ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Head Elevation ◽  
Head Injured ◽  
Injured Patients

Effect of head elevation on intracranial pressure, cerebral perfusion pressure, and cerebral blood flow in head-injured patients

1992 ◽  
Vol 76 (2) ◽  
pp. 207-211 ◽  
Author(s):  
Zeev Feldman ◽  
Malcolm J. Kanter ◽  
Claudia S. Robertson ◽  
Charles F. Contant ◽  
Christopher Hayes ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Head Position ◽  
Horizontal Position ◽  
Head Elevation ◽  
Head Injured ◽  
The Mean ◽  
Injured Patients

✓ The traditional practice of elevating the head in order to lower intracranial pressure (ICP) in head-injured patients has been challenged in recent years. Some investigators argue that patients with intracranial hypertension should be placed in a horizontal position, the rationale being that this will increase the cerebral perfusion pressure (CPP) and thereby improve cerebral blood flow (CBF). However, ICP is generally significantly higher when the patient is in the horizontal position. This study was undertaken to clarify the issue of optimal head position in the care of head-injured patients. The effect of 0° and 30° head elevation on ICP, CPP, CBF, mean carotid pressure, and other cerebral and systemic physiological parameters was studied in 22 head-injured patients. The mean carotid pressure was significantly lower when the patient's head was elevated at 30° than at 0° (84.3 ± 14.5 mm Hg vs. 89.5 ± 14.6 mm Hg), as was the mean ICP (14.1 ± 6.7 mm Hg vs. 19.7 ± 8.3 mm Hg). There was no statistically significant change in CPP, CBF, cerebral metabolic rate of oxygen, arteriovenous difference of lactate, or cerebrovascular resistance associated with the change in head position. The data indicate that head elevation to 30° significantly reduced ICP in the majority of the 22 patients without reducing CPP or CBF.

scholarly journals Left or right, up or down: A case for positioning of unconcious head-injured patients

Curationis ◽  
1992 ◽  
Vol 15 (1) ◽  
Author(s):  
M. Hugo
Keyword(s):  
Intracranial Pressure ◽  
Cerebral Perfusion Pressure ◽  
Nursing Care ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Negative Influence ◽  
Head Injured ◽  
Pressure Changes ◽  
Injured Patients ◽  
Increased Icp

Nursing care activities have been proved to cause increases in intracranial pressure (ICP) which could be detrimental to the patient’s health. Because positioning is one of the activities that causes the greatest pressure changes it was evaluated in this study. Cumulative increases also occur when nursing care activities are carried out in quick succession. The analysis of the data and literature suggest that the backrest position with the head of the bed elevated 30 to 45 degrees is the best position for a patient with increased ICP. If further research should prove that this position has a negative influence on the cerebral perfusion pressure, these recommendations will have to be revised.

scholarly journals The Effect of Indomethacin on Intracranial Pressure, Cerebral Perfusion and Extracellular Lactate and Glutamate Concentrations in Patients with Fulminant Hepatic Failure

2004 ◽  
Vol 24 (7) ◽  
pp. 798-804 ◽  
Author(s):  
Flemming Tofteng ◽  
Fin Stolze Larsen
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Intracranial Pressure ◽  
Cerebral Perfusion Pressure ◽  
Fulminant Hepatic Failure ◽  
Hepatic Failure ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Early Death ◽  
Cerebral Blood Flow Autoregulation

Uncontrolled increase in intracranial pressure (ICP) continues to be one of the most significant causes of early death in patients with acute liver failure (ALF). In this study, we aimed to determine the effects of indomethacin on ICP and cerebral perfusion pressure in twelve patients with ALF and brain edema (9 females/3 males, median age 49,5 (range 21 to 64) yrs.). Also changes in cerebral perfusion determined by transcranial Doppler technique (Vmean) and jugular bulb oxygen saturation (SvjO2) were measured, as well as brain content of lactate and glutamate by microdialysis technique. Finally, we determined the cerebral blood flow autoregulation before and after indomethacin injection. We found that indomethacin reduced ICP from 30 (7 to 53) to 12 (4 to 33) mmHg ( P < 0.05). The cerebral perfusion pressure increased from 48 (0 to 119) to 65 (42 to 129) mmHg ( P < 0.05), while Vmean and SvjO2 on average remained unchanged at 68 (34 to 126) cm/s and 67 (28 to 82) %, respectively. The lactate and glutamate in the brain tissue were not altered (2.1 (1.8 to 7.8) mmol/l and 34 (2 to 268) μmol/l, respectively) after injection of indomethacin. Cerebral blood flow autoregulation was impaired in all patients before injection of indomethacin, but was not restored after administration of indomethacin. We conclude that a bolus injection of indomethacin reduces ICP and increases cerebral perfusion pressure without compromising cerebral perfusion or oxidative metabolism in patients with ALF. This finding indicates that indomethacin may be valuable as rescue treatment of uncontrolled intracranial hypertension in fulminant hepatic failure.

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