Rethinking physiologic stability: touch and intracranial pressure

The purpose of this research was to examine the contingent nature of physiologic stability with respect to the impact of nursing and parental care touch on intracranial pressure (ICP) in children. Data were reanalyzed from those previously collected in eight children in a pediatric intensive care unit who had intracranial hypertension from a variety of causes and whose ICP was invasively monitored. One hundred forty-nine clusters of spontaneous touch/talking were available for analysis after those occurring close in time to procedures and drugs affecting ICP were dropped. Twenty-three episodes of investigator touch (without talking) were also analyzed. ICP stability was defined as any tracing over a defined time period in which the peak-to-trough amplitude did not exceed twice the calculated resting variability. Such an approach allowed classification and counting of stable versus unstable baselines, and stable versus unstable responses to touch. Therefore, ICP stability was examined by comparing the stability of the ICP tracing the last minute prior to a cluster of nonprocedural touch (baseline) with the first minute after the cluster. Clusters of spontaneous touch were nearly always associated with talking to the child and rarely were followed by change in level of ICP greater than that child's ICP variability at rest. Investigator stroking without talking never was followed by a significant change in level of ICP. There was a contingent relationship between stability of the ICP tracing prior to a cluster of touching/talking such that the probability of ICP becoming more stable when the touch/talk occurred on an unstable baseline was twice that of touch/talk occurring on an stable baseline.