Effect of head elevation on intracranial pressure, cerebral perfusion pressure, and cerebral blood flow in head-injured patients.

@article{Feldman1992EffectOH,
  title={Effect of head elevation on intracranial pressure, cerebral perfusion pressure, and cerebral blood flow in head-injured patients.},
  author={Zeev Feldman and Malcolm J. Kanter and Claudia S. Robertson and Charles F. Contant and C. Hayes and Michael A. Sheinberg and Chapal Villareal and Raj K. Narayan and Robert G. Grossman},
  journal={Journal of neurosurgery},
  year={1992},
  volume={76 2},
  pages={
          207-11
        }
}
The traditional practice of elevating the head in order to lower intracranial pressure (ICP) in head-injured patients has been challenged in recent years. Some investigators argue that patients with intracranial hypertension should be placed in a horizontal position, the rationale being that this will increase the cerebral perfusion pressure (CPP) and thereby improve cerebral blood flow (CBF). However, ICP is generally significantly higher when the patient is in the horizontal position. This… 
View on PubMed
thejns.org
280 Citations
Highly Influential Citations
15
Background Citations
58
Methods Citations
7
Results Citations
7

280 Citations

Citation Type

Citation Type

Influence of body position on tissue-pO2, cerebral perfusion pressure and intracranial pressure in patients with acute brain injury.
TLDR
The data indicate that a moderate head elevation of 30 degrees reduces cerebral perfusion pressure (CPP) without jeopardizing regional cerebral microcirculation as monitored using a polarographic ti-pO2 microcatheter.
Effects of Head Posture on Cerebral Hemodynamics: Its Influences on Intracranial Pressure, Cerebral Perfusion Pressure, and Cerebral Oxygenation
TLDR
Routine nursing of patients with severe head injury at 30 degrees of head elevation within 24 hours after trauma leads to a consistent reduction of ICP and an improvement in CPP (although not statistically significant) without concomitant deleterious changes in cerebral oxygenation.
Is cerebral perfusion pressure a major determinant of cerebral blood flow during head elevation in comatose patients with severe intracranial lesions?
TLDR
During head elevation the arteriovenous pressure gradient is the major determinant of CBF, and the influence of CPP on CBF decreases from 0 to 45 degrees of head elevation.
Influence of body position on jugular venous oxygen saturation, intracranial pressure and cerebral perfusion pressure.
TLDR
The data suggest that an individual approach to head elevation is to be preferred, and a moderate head elevation between 15 degrees and 30 degrees significantly reduces ICP and, in general, does not impair cerebral perfusion.
Effects of Body Position on Intracranial Pressure and Cerebral Perfusion in Patients With Large Hemispheric Stroke
TLDR
In patients with large hemispheric stroke without an acute ICP crisis, cerebral perfusion pressure was maximal in the horizontal position although ICP was usually at its highest point, which could be considered more desirable than the absolute level of ICP.
Dynamics of intracranial pressure, mean arterial pressure and cerebral perfusion pressure at change of head-of-bad position for patients with non-traumatic intracranial hemorrhages
TLDR
Positioning of patients with subarachnoid hemorrhages has no essential impact on the studied parameters and for patients with parenchymatous hemorrhages is preferable «head-of-bed» situation 30° and 60° the first and third day and 30° for the second and fifth day.
Effect of Head Positioning on Intracranial Blood Flow Velocities in Acute Ischemic Stroke: A Pilot Study
TLDR
The findings from this small sample suggest that patients with acute ischemic stroke may benefit from lower HOB positions, in particular flat positioning, to promote an increase in flow to isChemic brain tissue that may ultimately reduce brain infarct volume.
Effect of head and body positioning on cerebral blood flow velocity in patients who underwent cranial surgery.
TLDR
The results of this study showed that head elevation of the patients, who underwent cranial surgery, should be 30° during the nursing care to provide optimum cerebral blood flow.
Intracranial pressure and cerebral perfusion pressure responses to head elevation changes in pediatric traumatic brain injury*
TLDR
In severe pediatric traumatic brain injury, the relationship between change in head of the bed and change in intracranial pressure was negative and linear.
The management of cerebral perfusion pressure and intracranial pressure after severe head injury.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 28 REFERENCES
Cerebral perfusion pressure, intracranial pressure, and head elevation.
TLDR
It is concluded that 0 degree head elevation maximizes CPP and reduces the severity and frequency of pressure-wave occurrence and adequate hydration and avoidance of pharmacological agents that reduce SABP or prevent its rise are required to maximize CPP.
Cerebral and cardiovascular responses to changes in head elevation in patients with intracranial hypertension.
TLDR
A moderate degree of head elevation provides a consistent reduction of ICP without concomitant compromise of cardiac function, and lower (0 degrees) or higher (60 degrees) degrees ofHead elevation may be detrimental to the patient because of changes in the ICP, CPP, and cardiac output.
Correct Measurement of Cerebral Perfusion Pressure (CPP)
TLDR
Previous investigations on CPP used varying mathematical methods for calculation of the mean arterial pressure, and the optimal grade of head elevation in intracranial hypertension is still under discussion.
Significance and Management of Intracranial Hypertension in Head Injury
TLDR
The purpose, rather, is to focus on causes and effects of raised ICP in patients with head injury and some aspects of treatment of intracranial hypertension.
Effect of posture on intracranial pressure and cerebral perfusion pressure in patients with fulminant hepatic and renal failure after acetaminophen self-poisoning.
TLDR
This study does not support the current practice of nursing patients with hepatic coma, who are at risk of dying from cerebral edema, in head-upright postures greater than 20 degrees.
Cerebral perfusion pressure management in head injury.
TLDR
This approach to the management of intracranial hypertension proved safe, rational, and greatly enhanced the therapeutic options available, and was also consistent with optimal care of other organ systems.
Pressure-volume index in head injury.
TLDR
A clear relationship between the PVI measured soon after injury and subsequent development of ICP emerged, and the degree of reduction and extent of biomechanical recovery are closely related to outcome and development of raised ICP.
Body position and cerebrospinal fluid pressure. Part 1: clinical studies on the effect of rapid postural changes.
TLDR
Waves were mainly caused by changes in cerebral blood volume probably reflecting the postural BP wave and brain autoregulation and most patients with stationary and large transient waves also manifested clinical symptoms.
High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury.
TLDR
The hypothesis that high-dose pentobarbital is an effective adjunctive therapy, but that it is indicated in only a small subset of patients with severe head injury is supported.
The Vasodilatory Cascade and Intracranial Pressure
TLDR
Previous reports by this investigator suggest that CSF pressure waves are the reflection of a mostly intact and autoregulating cerebral vascular bed interacting with an unstable cerebral perfusion pressure (CPP) usually induced by subtle changes in systemic arterial blood pressure (SABP).
...
1
2
3
...