Management of intracranial hemodynamics in the adult: a research analysis of head positioning and recommendations for clinical practice and future research.
Head elevation is a conventional nursing intervention used to control raised intracranial pressure and avoid complications in patients with neurotrauma or other conditions requiring management of intracranial hemodynamics. This therapy, however, provides a particular dilemma for health care providers. While elevating the head of the bed does decrease intracranial pressure, it may put some patients at risk for intracranial hypertension and cerebral ischemia due to decreases in cerebral perfusion pressure. This article analyzes research on head positioning that provides individual outcome measurements versus group means in adult patients with various conditions. The risk/benefit method of analysis used in this review revealed that in addition to only monitoring and controlling for ICP, we must also monitor and control CPP with a greater emphasis on this particular measurement. This analysis also revealed that optimal head positioning to manage intracranial hemodynamics should be decided upon on an individual basis using both ICP and CPP measurements.
Simmons
B J
BJ
D000328:Adult; D001921:Brain / Q000098:blood supply*; D001929:Brain Edema / Q000451:nursing / Q000503:physiopathology; D001930:Brain Injuries / Q000451:nursing* / Q000503:physiopathology; D001932:Brain Neoplasms / Q000451:nursing / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D011187:Posture / Q000502:physiology*; D011559:Pseudotumor Cerebri / Q000451:nursing* / Q000503:physiopathology