title: Systematic review of decreased intracranial pressure with optimal head elevation in postcraniotomy patients: a meta-analysis.
abstract: OBJECTIVE
  To determine an optimal head elevation degree to decrease intracranial pressure in postcraniotomy patients by meta-analysis.
  
  
  BACKGROUND
  A change in head position can lead to a change in intracranial pressure; however, there are conflicting data regarding the optimal degree of elevation that decreases intracranial pressure in postcraniotomy patients.
  
  
  METHODS
  Quantitative systematic review with meta-analysis following Cochrane methods.
  
  
  METHODS
  The data were collected during 2014; three databases (PubMed, Embase and China National Knowledge Internet) were searched for published and unpublished studies in English. The bibliographies of the articles were also reviewed. The inclusion criteria referred to different elevation degrees and effects on intracranial pressure in postcraniotomy patients.
  
  
  METHODS
  According to pre-determined inclusion criteria and exclusion criteria, two reviewers extracted the eligible studies using a standard data form.
  
  
  RESULTS
  These included a total of 237 participants who were included in the meta-analysis. (1) Compared with 0 degree: 10, 15, 30 and 45 degrees of head elevation resulted in lower intracranial pressure. (2) Intracranial pressure at 30 degrees was not significantly different in comparison to 45 degrees and was lower than that at 10 and 15 degrees.
  
  
  CONCLUSIONS
  Patients with increased intracranial pressure significantly benefitted from a head elevation of 10, 15, 30 and 45 degrees compared with 0 degrees. A head elevation of 30 or 45 degrees is optimal for decreasing intracranial pressure. Research about the relationship of position changes and the outcomes of patient primary diseases is absent.
authors.affiliation: Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Zeng pan-pan
authors.initials: Zp
authors.lastname: Ye
authors.affiliation: Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Chao
authors.initials: C
authors.lastname: You
authors.affiliation: Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Hu
authors.affiliation: Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Sen
authors.initials: S
authors.lastname: Lin
authors.affiliation: Department of Nursing, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Ji-Pin
authors.initials: JP
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000503:physiopathology / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000503:physiopathology / Q000517:prevention & control*; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods*; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D055815:Young Adult
keywords: adult nursing; advanced practice; clinical guidelines; craniotomy; evidence-based practice; head elevation; head injury; neurosurgery