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Chapter 5 cerebral perfusion pressure and intracranial pressure in traumatic brain injury
Insights
Nursing research on traumatic brain injury (TBI) shows that most nursing activities do not uniformly affect intracranial pressure (ICP) or cerebral perfusion pressure (CPP). Individual patient responses necessitate close monitoring and personalized care strategies.
Area of Science:
- Neurology
- Nursing Research
- Critical Care
Background:
- Traumatic brain injury (TBI) affects nearly 300,000 individuals annually, requiring monitoring of intracranial pressure (ICP) and cerebral perfusion pressure (CPP).
- Nurses utilize ICP and CPP data to assess the risk of secondary brain injury in TBI patients.
- Nursing research in this area focuses on ICP and CPP monitoring relevant to the care of TBI patients.
Purpose of the Study:
- To review existing nursing research on the monitoring of ICP and CPP in patients with TBI.
- To identify nursing interventions and patient positions that impact ICP and CPP.
- To guide future nursing research directions in TBI care.
Main Methods:
- A modified systematic review of relevant literature was conducted.
- Studies examining the effects of body positions and nursing activities on ICP and CPP were analyzed.
- Research involving both ICP and CPP measurements was specifically considered.
Main Results:
- Most nursing activities and body positions, excluding sharp head rotation and prone positioning, do not consistently alter ICP.
- CPP often remains stable due to parallel increases in arterial blood pressure with ICP.
- Significant individual variations in cerebrodynamics highlight the need for patient-specific care.
Conclusions:
- Clinical practice requires close attention to individual patient responses to nursing care maneuvers.
- Future research should adopt an integrated approach, linking comprehensive nursing care to patient outcomes.
- Intervention trials focusing on controllable nursing aspects like noise reduction and early mobilization are crucial for TBI patient care.
Abstract:
Nearly 300,000 children and adults are hospitalized annually with traumatic brain injury (TBI) and monitored for many vital signs, including intracranial pressure (ICP) and cerebral perfusion pressure (CPP). Nurses use these monitored values to infer the risk of secondary brain injury. The purpose of this chapter is to review nursing research on the monitoring of ICP and CPP in TBI. In this context, nursing research is defined as the research conducted by nurse investigators or research about the variables ICP and CPP that pertains to the nursing care of the TBI patient, adult or child. A modified systematic review of the literature indicated that, except for sharp head rotation and prone positioning, there are no body positions or nursing activities that uniformly or nearly uniformly result in clinically relevant ICP increase or decrease. In the smaller number of studies in which CPP is also measured, there are few changes in CPP since arterial blood pressure generally increases along with ICP. Considerable individual variation occurs in controlled studies, suggesting that clinicians need to pay close attention to the cerebrodynamic responses of each patient to any care maneuver. We recommend that future research regarding nursing care and ICP/CPP in TBI patients needs to have a more integrated approach, examining comprehensive care in relation to short- and long-term outcomes and incorporating multimodality monitoring. Intervention trials of care aspects within nursing control, such as the reduction of environmental noise, early mobilization, and reduction of complications of immobility, are all sorely needed.
