title: The effect of nursing interventions on the intracranial pressure in paediatric traumatic brain injury.
abstract: OBJECTIVE
  The aim of this research was to investigate the effect of five selected intensive care nursing interventions on the intracranial pressure (ICP) of moderate to severe traumatic brain-injured children in intensive care.
  
  
  BACKGROUND
  The physiological effects of many nursing interventions in paediatric intensive care (PIC) are not known. This results in the lack of an evidence base for many PIC nursing practices.
  
  
  METHODS
  Prospective observational cohort study conducted over 3 years in a single tertiary referral paediatric intensive care unit (PICU) in the North West of England.
  
  
  METHODS
  Five selected commonly performed nursing interventions were studied: endotracheal suctioning and manual ventilation (ETSMV), turning via a log-rolling (LR) approach, eye care, oral care and washing. These were studied in the first 72 h after injury.
  
  
  RESULTS
  A total of 25 children with moderate to severe traumatic brain injury and intraparenchymal ICP monitoring in intensive care (aged 2-17 years) were enrolled. Both ETSMV and LR were associated with clinically and statistically significant changes in ICP from baseline to maximal ICP (p = 0·001 ETSMV; p = < 0·001 LR) and from maximal post-ICP (p = < 0·001 ETSMV; p = < 0.001 LR). Eye care, oral care or washing did not cause any clinically significant change in ICP from baseline. After decompressive craniectomy, none of the interventions caused significant changes in ICP.
  
  
  CONCLUSIONS
  Only two of the five nursing interventions, endotracheal suctioning and LR, caused intracranial hypertension in moderate to severe traumatic brain-injured children, and after craniectomy, no care interventions caused any significant change in ICP.
  
  
  CONCLUSIONS
  Knowledge about the physiological effects of many intensive care nursing interventions is lacking and this is magnified in paediatrics. This study provides a significant addition to the evidence base in this area and allows intensive care nurses to plan, implement and evaluate more effectively their nursing care for brain-injured children.
authors.affiliation: PICU, Alder Hey Children's NHS Foundation Trust/Liverpool John Moores University, Liverpool, UK. lyvonne.tume@alderhey.nhs.uk
authors.forename: Lyvonne N
authors.initials: LN
authors.lastname: Tume
authors.forename: Paul B
authors.initials: PB
authors.lastname: Baines
authors.forename: Paulo J G
authors.initials: PJ
authors.lastname: Lisboa
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis / Q000401:mortality / Q000451:nursing* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D015331:Cohort Studies; D003399:Craniotomy / Q000379:methods / Q000451:nursing; D003422:Critical Care / Q000458:organization & administration; D019299:Decompression, Surgical / Q000379:methods / Q000451:nursing; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration; D019586:Intracranial Hypertension / Q000209:etiology* / Q000451:nursing* / Q000628:therapy; D007427:Intracranial Pressure; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008991:Monitoring, Physiologic / Q000009:adverse effects / Q000451:nursing; D020380:Needs Assessment; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D011446:Prospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom