ACUTE HEAD INJURY � intensive care management
NICE GUIDELINES (2007)
www.nice.org.uk/nicemedia/pdf/CG56NICEGuideline.pdf
European Brain Injury Consortium GUIDELINES (2005)
www.springerlink.com/content/p24319717028562n/
Arbour R (1998) Aggressive management of intracranial dynamics. Crit.Care Nurse, 18, 3, 30-40
head elevation can cause hypotension in hypovolaemic patients
Bein T et al (2002) Lung recruitment maneuver in patients with cerebral injury. Int Care Med, 28, 554-8
volume recruitment maneuver can raise ICP with only marginal improvement in oxygenation
Brimioulle S, Moraine J-J, Norrenberg D (1997) Effects of positioning and exercise on ICP in a neurosurgical ICU. Phys Ther, 77, 1682-9
passive movements can transiently increase ICP
Brucia J (1996) The effect of suction catheter insertion and tracheal stimulation in adults with severe brain injury. Heart Lung, 25, 295-303
Caricato A (2005) Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage J Trauma-Injury Inf Crit Care, 58, 571-6
www.jtrauma.com/pt/re/jtrauma/abstract.00005373-200503000-00021.htm;jsessionid=CO5EKlmYRMKPcbJGGy72sAD2B6RZWJFeF315LiHLGi1QDiEb20Jw!1707623050!-949856031!9001!-1
monitoring respiratory compliance may be useful for avoiding deleterious effects of PEEP on ICP
Cekic M, Cutler SM (2011) Vitamin D deficiency reduces the benefits of progesterone treatment after brain injury in aged rats. Neurobiology of Aging, 32, 5, 864-74
www.neurobiologyofaging.org/article/S0197-4580%2809%2900144-4/abstract
vitamin D deficiency can increase brain inflammation and attenuate the benefits of progesterone
Ηelik S (2004) Nursing role on preventing secondary brain injury. Acc Emerg Nurs, 12, 94-8
comprehensive information on preventing some of the 35% of damage that occurs after the initial injury.
Chida Y (2008) A bidirectional relationship between psychosocial factors and atopic disorders: a systematic review and meta-analysis. Psychosom Med, 70, 102-116
www.psychosomaticmedicine.org/cgi/content/abstract/70/1/102
strong relationship between psychosocial factors and atopic disorders
Casanova E, Lazzari RE, Lotta S (2003) Locked-in syndrome: improvement in the prognosis after an early intensive multidisciplinary rehabilitation. Arch Phys Med Rehab, 84, 862-7
intensive early rehabilitation, begun within about 1 month of the morbid event, improved functional recovery and reduced mortality.
Chudley (1994) The effect of nursing activities on ICP. Br J Nurs, 3, 454-9.
relatives talking to patient reduces their ICP, stroking patients cheek reduces ICP, positioning is safe with ICP below 15 and CPP above 50 mmHg
Cooper DJ (2011) Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med, 364, 1493
surgery to reduce pressure in the brain may decrease ICP but led to more unfavorable outcomes.
Dettbarn CL, Davidson LJ (1989) Pulmonary complications in the patient with acute head injury. Heart Lung, 18, 583-9.
mechanism of neurogenic pulmonary oedema; effect of cumulative procedures on ICP
Dziedzic T (2004) Nosocomial infections and immunity: lesson from brain-injured patients Crit Care, 8, 266-70
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15312209&dopt=Abstract
nosocomial infections may occur because brain damage can cause transient immunodepression
Ersson U (1990) Observations on intracranial dynamics during respiratory physiotherapy in unconscious neurosurgical patients. Acta Anaesthesiol.Scand, 34, 99-103
manual hyperinflation and suction both reduce cerebral perfusion pressure; to minimise this, patients should be sedated before physio
Edouard AR (2005) Non-invasive assessment of cerebral perfusion pressure in brain injured patients. Br J Anaesth, 94, 216-21
Fan J-U (2004) Effect of backrest position on intracranial pressure and cerebral perfusion pressure in individuals with brain injury. J Neuroscience Nurs, 36, 5
journals.lww.com/jnnonline/Abstract/2004/10000/Effect_of_Backrest_Position_on_Intracranial.7.aspx
systematic review identifying in what circumstances head elevation is and isnt beneficial
Garradd J, Bullock M (1986) The effect of respiratory therapy on ICP in ventilated neurosurgical patients. Aust J Physiother, 32, 107-11.
coughing, suction, MHI and vibrations lead to increased ICP
Haitsma IK, Maas AIR (2002) Advanced monitoring in the intensive care unit: brain tissue oxygen tension. Curr Opin Crit Care, 8, 115-20
www.lwwonline.com/pt/re/lwwonline/abstract.00075198-200204000-00005.htm;jsessionid=CM9aEHKwlTUXg3TCXi9hy0Tpj9H7Znog8Xic4mfO9KggYkySQQAs!1707623050!-949856031!9001!-1?index=1&results=1&count=10&searchid=1&nav=search&database=lwwovft
continuous monitoring of brain tissue oxygen tension helps maintain cerebral oxygenation
Jeremitsky E (2005) The impact of hyperglycemia on patients with severe brain injury. J Trauma-Injury Inf Crit Care, 58, 47-51
www.jtrauma.com/pt/re/jtrauma/abstract.00005373-200501000-00008.htm;jsessionid=CO5EKlmYRMKPcbJGGy72sAD2B6RZWJFeF315LiHLGi1QDiEb20Jw!1707623050!-949856031!9001!-1
early hyperglycemia is associated with poor outcome in traumatic brain injury; tight control of glucose without reduction of nutritional support may improve prognosis
Jones B. (1995) The effects of patient repositioning on intracranial pressure. Austr J Adv Nurs, 12, 2, 32-9.
Kerr ME (1993) Head-injured adults: recommendations for endotracheal suctioning. J Neuroscience Nursing, 25, 2, 86-91
Koch SM (1996) Effect of passive range of motion on ICP in neurosurgical patients. J Crit Care, 11, 176-9
passive range of motion does not affect ICP in stable patients without intracranial hypertension
Lee,S-T (1989) Intracranial pressure changes during positioning of patients with severe head injury. Heart Lung, 18, 411-14.
head-down tilt increases ICP
MacKay (1992) Early intervention in severe head injury. Arch Phys Med Rehab, 73, 635-41
length of coma cut to a third by rehab starting in ICU
Marion DW (2002) Increasing blood pressure causes a decrease in ICP in patients with brain injury. Crit Care Med, 30, 1671-2
maintaining BP assists management of ICP
Mayer SA, Chong JY (2002) Critical care management of increased intracranial pressure. J Int Care Med, 17, 55
ICP monitoring is essential in managing ICP effectively
Mitchell PH (1978) Relationship of patient-nurse activity to ICP variations. Nurs Research, 27, 4-10.
venous outflow from the brain is impeded by hip flexion
talking over the patient increases ICP
Mitchell PH (1981) Moving the patient in bed: effects on ICP. Nurs Research, 30, 212-18.
raised ICP is caused by noise, pain, restraints, movement of tracheal tube, arousal from sleep or distress
Oh BC, Holcomb JB (2011) Traumatic brain injury and resuscitation with blood products. Crit Care, 15, 172
ccforum.com/content/15/4/172/abstract
Olmos L (2003) Emotion processing in the minimally conscious state. Arch Phys Med Rehab, 84, E7
patients in minimally-conscious state show response to familiar voice
Petrov YY, Prough DS (2005) Optoacoustic, noninvasive, real-time, continuous monitoring of cerebral blood oxygenation. Anesthesiol, 102, 69-77
www.anesthesiology.org/pt/re/anes/abstract.00000542-200501000-00014.htm;jsessionid=CfLTPPMCuOMZoTJYKxVKLX6LC9oEXG3PCpM4feVzBgwgnPYD7nBn!-1757678366!-949856031!9001!-1
Paratz (1993) The effect of respiratory physiotherapy on ICP, BP, CPP and ETCO2 in ventilated neurosurgical patients. Physioth Theory Pract, 9, 3-11.
effect on ICP of coughing, suction, MHI, vibs, percussion - stop treatment if BP drops or ICP rises
Raphael JH (1994) Effects of the cervical collar on CSF pressure. Anaesthes, 49, 437-9.
cervical collar can raise ICP
Rudy (1991) Endotracheal suctioning in adults with head injury.
Heart Lung, 20, 667-27.
rebound increase in ICP may occur 10 minutes after suction
Schlosser H-G (2009) Vestibulo-occular monitoring as a predictor of outcome after severe traumatic brain injury. Crit Care, 13, R192
ccforum.com/content/13/6/R192
Seel RT et al (2003) Depression after traumatic brain injury. Arch Phys Med Rehab, 84, 177-84
depression is common, causes fatigue and distractibility, and requires evaluation and treatment protocols
Singer BJ et al (2003) Evaluation of serial casting to correct equinovarus deformity of the ankle after acquired brain injury. Arch Phys Med Rehab, 84, 483-91
serial casting effective in decreasing deformity and increasing mobility
Sisson (1990) Effects of auditory stimuli on comatose patients with head injury. Heart Lung, 19, 373-8
unconscious patients can hear everything
Snyder (1983) Relation of nursing activites on ICP. J Adv Nursing, 8,273-9
ICP increases when staff talk over patient, ICP reduces when families talk to and touch patient
Valadka AB (2000) Global and regional techniques for monitoring cerebral oxidative metabolism after severe traumatic brain injury. Neurosurg Focus, 9, 5.
Watson MJ (2001) Do patients with severe traumatic brain injury benefit from physiotherapy? Phys Ther Rev, 6, 233-49
literature review shows reasonable body of evidence of the benefit of physiotherapy
Yanko JR (2001) Acute care management of severe traumatic brain injuries. Crit Care Nurs Q, 23, 4, 1-23
fluids and BP control, environment control, temperature control, nutrition, drugs, surgery, IPPV
CPP = cerebral perfusion pressure
ICP = intracranial pressure
MHI = manual hyperinflation