Changes in intracranial pressure associated with chest physiotherapy.
BACKGROUND
Management of intracranial hypertension is pivotal in the care of brain-injured patients.


METHODS
We report the case of a patient with both a closed head injury and anoxic encephalopathy, who subsequently experienced episodes of refractory intracranial hypertension. The patient's care was complicated by the development of a pneumonia, which required frequent turning of the patient and chest physiotherapy. Conventional wisdom suggests that these interventions may stimulate the patient and worsen intracranial pressure, and therefore should be avoided.


RESULTS
Our observations on this patient, however, contradict this belief. This single-subject study presents data to support the use of chest physiotherapy in patients at risk for intracranial hypertension.


CONCLUSIONS
Further, the evidence is compelling that a randomized-controlled trial is indicated to test the hypothesis that chest physiotherapy may actually result in short-term resolution of high intracranial pressure, and thus provide one more clinical tool in the management of elevated intracranial pressure.
Olson
DaiWai M
DM
The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. dmolson@email.unc.edu
Thoyre
Suzanne M
SM
Turner
Dennis A
DA
Bennett
Stacey
S
Graffagnino
Carmelo
C
D000328:Adult; D005260:Female; D016489:Head Injuries, Closed / Q000150:complications* / Q000628:therapy; D006801:Humans; D002534:Hypoxia, Brain / Q000150:complications* / Q000628:therapy; D019586:Intracranial Hypertension / Q000209:etiology* / Q000517:prevention & control*; D026741:Physical Therapy Modalities; D053717:Pneumonia, Ventilator-Associated / Q000628:therapy*; D016896:Treatment Outcome