The Effcet Of Body Position And Intermittent Pneumatic Compression On Intracranial Pressure In Patients With Sever Traumatic Brain Injury

ObjectiveThe study aims to analyze the effect of turning and positioning on ICP,during acute phase of 12～24 hours after craniotomy operation,the severe traumatic brain injury patients were implemented postural changess;during acute phase of 12～24 hours after neuro surgical surgery in patients with severe traumatic brain injury,we also observe the changes of intracranial pressure after manual intervention about turning and positioning combining with intermittent pneumatic compression.And further to discuss whether there are the optimum postural and the most appropriate intermittent pneumatic compression treatment programs.The objective of this study is to provide guidance for clinical care,in order to ensure the safety of turning and positioning patients and the therapy of intermittent pneumatic compression.Methods1.We selected 29 Patients diagnosed with severe traumic brain injury admitted to the neuro-ICU in Hospital,each patient underwent the ICP monitoring,in a prospective observational repeated measures study,we examined the effects of 12 different body positions on intracranial pressure,patients were exposed to all 12 positions in random order at 1-hour intervals.we use lateral position combining with head of bed (HOB),the 12 study positions were supine, supine with knee bent, left lateral position,and right lateral position,and in each of these positions, the HOB then was elevated to 15°、30°、or 45°.And we recorded and analyzed the intracranial pressure changes.2.We selected 40 patients diagnosed with severe traumic brain injury admitted to the neuro-ICU in Hospital,each patient underwent the ICP monitoring,were divided into the group A (n=20) and control group B (n=20) according to the order of admission.They receive the threpy of intermittent pneumatic compression in 12～24 hours after neurosurgical surgery.We combined the HOB 15°、30° with the three models and the two pressures of intermittent pneumatic compression.Group A was positioned with supine HOB 15°,and Group B was positioned with supine HOB 30°,all patients in both groups were underwent intermittent pneumatic compression treatment with the three models and the two pressures,they all used bilateral lower extremity full leg jacket.we recorded and analyzed the intracranial pressure changes before、during、and after the tharapy.Results1.When we impleted postural changes,the comparison of intracranial pressure changes from baseline to postposition assessment mean change scores had the following changes:supine with HOB15° from (15.27±3.53)to(18.31±3.84)mmHg,P< 0.05; supine with HOB 30°from (18.86±4.60)to(14.86±4.56)mmHg,P<0.05;supine with HOB 45°from (18.24±3.97) to(15.63±4.31) mmHg,P<0.05; left lateral with HOB 15°from (14.68±4.14) to (20.93±3.94) mmHg,P<0.05; left lateral with HOB30°from (15.41±3.73) to (19.55±3.52) mmHg,P<0.05; left lateral with HOB45°from (16.00±4.31) to (18.79±4.04) mmHg,P<0.05; right lateral with HOB 15°from(14.82±3.93)to(21.20±4.02)mmHg,P<0.05; right lateral with HOB30°from (16.06±3.68) to (19.89±3.81) mmHg,P<0.05; right lateral with HOB45°from (16.07±3.67) to (19.55±4.22) mmHg,P<0.05; and knee elevation with HOB 15°from(15.82±4.27)to(18.13±3.59)mmHg,P<0.05;, knee elevation with HOB 30°from (16.27±3.51) to (16.48±3.76) mmHg,P=0.77、knee elevation with HOB 45°from (16.20±4.27) to (16.75±3.58mmHg),P=0.35.2.The effect of postural intervention combined with intermittent pneumatic compression on intracranial pressure:when we impleted intermittent pneumatic compression treatment for two grups,we do not observed significant changes before and after the therapy of two pressures and three models,P> 0.05; we observed significant changes in compression phase compareing with before and after the therapy,P< 0.05; we do not observed significant changes in deflation phase compareing with before and after the therapy,P> 0.05; we do not observed significant changes about ICP extent in two groups using the therapy with 8 kPa,P> 0.05; we observed significant changes about ICP extent in group A using the therapy with 10 kPa and model P1、P2、P3,P<0.05; we do not observed significant changes about ICP extent in group B using the therapy with 10 kPa and model P1,P>0.05; we observed significant changes about ICP extent in group B using modelsP2、P3.Conclusion1.The turing and positioning can effect intracranial pressure in patients with Severe traumatic brain injury.The comparison of intracranial pressure changes from baseline to postposition assessment mean change scores:Ten positions led to a significant change in ICP:(a)supine with HOB 30°、45°(decrease), (b) left lateral with HOB 15°、30°、45°(increase), (c) right lateral with HOB 15°、30°、45°(increase), and (d) knee elevation with HOB 15°and supine with HOB 15°(increase).Two positions led to no significant change in ICP:knee elevation with HOB 30°、45°.We suggest that in the absence of monitoring, we can implet HOB 30°、45°and knee elevation with HOB 30°、45° for during acute phase of 12-24 hours after neuro surgical surgery in patients with severe traumatic brain injury. And we implet lateral、supine with HOB 15° and knee elevation with HOB 15° with caution.2.Both lower limbs receive intermittent pneumatic compression in 12～24 hours after craniotomy, we observed significant changes in compression phase compareing with before and after the therapy, especially using 10kPa.We suggest that we can implet HOB 15°、30° with 8kPa and three models,HOB 30°with model P1 and 8kPa maybe the most appropriate intermittent pneumatic compression treatment programs,we use lOkPa with HOB 15°carefuly. And we need obseve intracranial pressure carefully in the compression phase of intermittent pneumatic compression treatment,we need suspend the therapy when it is necessary.