Acute management of acquired brain injury part I: an evidence-based review of non-pharmacological interventions.
OBJECTIVE
To review the literature on non-pharmacological interventions used in acute settings to manage elevated intracranial pressure (ICP) and minimize cerebral damage in patients with acquired brain injury (ABI).


RESULTS
A literature search of multiple databases (CINAHL, EMBASE, MEDLINE and PSYCHINFO) and hand-searched articles covering the years 1980-2008 was performed. Peer reviewed articles were assessed for methodological quality using the PEDro scoring system for randomized controlled trials (RCTs) and the Downs and Black tool for RCTs and non-randomized trials. Levels of evidence were assigned and recommendations made.


RESULTS
Five non-invasive interventions for acute ABI management were assessed: adjusting head posture, body rotation (continuous rotational therapy and prone positioning), hyperventilation, hypothermia and hyperbaric oxygen. Two invasive interventions were also reviewed: cerebrospinal fluid (CSF) drainage and decompressive craniectomy (DC).


CONCLUSIONS
There is a paucity of information regarding non-pharmacological acute management of patients with ABI. Strong levels of evidence were found for only four of the seven interventions (decompressive craniectomy, cerebrospinal fluid drainage, hypothermia and hyperbaric oxygen) and only for specific components of their use. Further research into all interventions is warranted.
Meyer
Matthew J
MJ
Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada.
Megyesi
Joseph
J
Meythaler
Jay
J
Murie-Fernandez
Manuel
M
Aubut
Jo-Anne
JA
Foley
Norine
N
Salter
Katherine
K
Bayley
Mark
M
Marshall
Shawn
S
Teasell
Robert
R
D000208:Acute Disease; D001930:Brain Injuries / Q000150:complications* / Q000601:surgery; D056424:Decompressive Craniectomy / Q000379:methods; D004322:Drainage / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods; D007036:Hypothermia, Induced / Q000379:methods; D019586:Intracranial Hypertension / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial