Intracranial hypertension: influence of nursing care activities

Although there has been concern that a variety of nursing care procedures may serve as potent adaptive demands in patients with intracranial hypertension, research shows that activities such as bathing, oral hygiene, touching, and suctioning produce relatively small increases in ICP and are accompanied by adequate CPP. Head rotation and flexion are potent stimuli to increased ICP, although CPP has remained adequate in the small number of people in whom it has been measured. While considerable descriptive work has been done with respect to a variety of nursing care activities, much remains to be done. Little is known about the mechanisms by which activities (turning and suctioning) effect demands upon the craniospinal system, nor what the best predictors are of individuals who will respond adversely to such demands. The potential of affective touch and environmental sensory stimulation to reduce ICP and reduce the need for potent pharmacologic agents is intriguing but has not been adequately explored. Further investigators need to attend to reporting individual as well as group patterns to guide clinical application and describe predictors of individual response. In addition, the oscillatory nature of ICP and cardiovascular variables needs to be taken into account in interpreting whether or not "real" change has occurred in response to given activities. The full range of cerebrovascular variables needs to be measured to determine if changes in ICP pose a threat to cerebral perfusion. Finally, we need to examine nursing therapeutics with respect to ultimate outcomes (functional recovery) as well as to individual care activities.