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

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.

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Intracranial pressure monitoring in severe head-injured patients: A practical method in delineation of adequate cerebral perfusion pressure and the preliminary result in Tri-Service General Hospital, Taiwan

Clinical Neurology and Neurosurgery ◽

10.1016/s0303-8467(97)81570-3 ◽

1997 ◽

Vol 99 ◽

pp. S67-S68

Author(s):

Cheng-Mao Cheng ◽

Shinn-Zong Lin ◽

Guann-Juh Chen ◽

Wen-Shin Song ◽

Chu-Wen Chou ◽

...

Keyword(s):

Intracranial Pressure ◽

General Hospital ◽

Cerebral Perfusion Pressure ◽

Cerebral Perfusion ◽

Perfusion Pressure ◽

Practical Method ◽

Intracranial Pressure Monitoring ◽

Pressure Monitoring ◽

Head Injured ◽

Injured Patients

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Cerebral perfusion pressure in head-injured patients: a noninvasive assessment using transcranial Doppler ultrasonography

Journal of Neurosurgery ◽

10.3171/jns.1998.88.5.0802 ◽

1998 ◽

Vol 88 (5) ◽

pp. 802-808 ◽

Cited By ~ 136

Author(s):

Marek Czosnyka ◽

Basil F. Matta ◽

Piotr Smielewski ◽

Peter J. Kirkpatrick ◽

John D. Pickard

Keyword(s):

Intracranial Pressure ◽

Cerebral Perfusion Pressure ◽

Transcranial Doppler ◽

Cerebral Perfusion ◽

Doppler Ultrasonography ◽

Perfusion Pressure ◽

Content Type ◽

Head Injured ◽

Injured Patients ◽

Fine Print

Object. The authors studied the reliability of a new method for noninvasive assessment of cerebral perfusion pressure (CPP) in head-injured patients in which mean arterial blood pressure (ABP) and transcranial Doppler middle cerebral artery mean and diastolic flow velocities are measured. Methods. Cerebral perfusion pressure was estimated (eCPP) over periods of continuous monitoring (20 minutes—2 hours, 421 daily examinations) in 96 head-injured patients (Glasgow Coma Scale score < 13) who were admitted to the intensive care unit. All patients were sedated, paralyzed, and ventilated. The eCPP and the measured CPP (ABP minus intracranial pressure, measured using an intraparenchymal microsensor) were compared. The correlation between eCPP and measured CPP was r = 0.73; p < 10−6. In 71% of the examinations, the estimation error was less than 10 mm Hg and in 84% of the examinations, the error was less than 15 mm Hg. The method had a high positive predictive power (94%) for detecting low CPP (< 60 mm Hg). The eCPP also accurately reflected changes in measured CPP over time (r > 0.8; p < 0.001) in situations such as plateau and B waves of intracranial pressure, arterial hypotension, and refractory intracranial hypertension. A good correlation was found between the average measured CPP and eCPP when day-by-day variability was assessed in a group of 41 patients (r = 0.71). Conclusions. Noninvasive estimation of CPP by using transcranial Doppler ultrasonography may be of value in situations in which monitoring relative changes in CPP is required without invasive measurement of intracranial pressure.

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