Positioning and intracranial hypertension: implications of the new critical pathway for nursing practice

Evidence based practice in nursing requires careful scrutiny of research studies to determine if there is support to continue existing protocols or if a change in clinical practice is warranted. Current nursing practice in critical care includes the routine elevation of the head of the bed (HOB) to 30 degrees or 45 degrees for patients with cerebral edema. Intracranial hypertension is a common complication of cerebral edema. New guidelines for medical management of intracranial hypertension have been developed and presented in a critical pathway. Positioning of patients with intracranial hypertension must be re-evaluated in light of the changing goals of medical management outlined in the critical pathway. The author of this article will critically appraise the research examining the impact of elevating the HOB on patients with intracranial hypertension within the context of the critical pathway parameters. Recommendations for positioning, in keeping with the new critical pathway for intracranial hypertension, will be suggested. Future research directions will be identified.