title: Acute management of acquired brain injury part I: an evidence-based review of non-pharmacological interventions.
abstract: 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.
authors.affiliation: Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Meyer
authors.forename: Joseph
authors.initials: J
authors.lastname: Megyesi
authors.forename: Jay
authors.initials: J
authors.lastname: Meythaler
authors.forename: Manuel
authors.initials: M
authors.lastname: Murie-Fernandez
authors.forename: Jo-Anne
authors.initials: JA
authors.lastname: Aubut
authors.forename: Norine
authors.initials: N
authors.lastname: Foley
authors.forename: Katherine
authors.initials: K
authors.lastname: Salter
authors.forename: Mark
authors.initials: M
authors.lastname: Bayley
authors.forename: Shawn
authors.initials: S
authors.lastname: Marshall
authors.forename: Robert
authors.initials: R
authors.lastname: Teasell
mesh_terms: 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