Changes in intracranial pressure associated with chest physiotherapy

Olson, DaiWai M.; Thoyre, Suzanne M.; Turner, Dennis A.; Bennett, Stacey; Graffagnino, Carmelo

doi:10.1007/s12028-007-0015-y

Cited by 12 publications

(7 citation statements)

References 14 publications

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“…[8][9][10][11][12][13][14][15][16][17] In contrast, administration of oral care by using either manual or electric toothbrushes among intubated neurologically impaired patients does not result in significant increases in ICP. 18,19 Similarly, Olson et al, in a series of 3 articles, 5,20,21 explored the effects of chest percussion therapy on ICP, finding that such therapy does not adversely affect ICP and may be associated with lower ICP for some patients. Although these interventions are often necessary to provide adequate care for critically ill patients, as they reduce risk of ventilatorassociated pneumonia and pressure ulcers, other nursing interventions are performed with the aim of specifically decreasing ICP values.…”

Section: Review Of Literaturementioning

confidence: 99%

Effects of Nursing Interventions on Intracranial Pressure

Olson

McNett

Lewis

et al. 2013

American Journal of Critical Care

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Background Intracranial pressure is a frequent target for goaldirected therapy to prevent secondary brain injury. In critical care settings, nurses deliver many interventions to patients having intracranial pressure monitored, yet few data documenting the immediate effect of these interventions on intracranial pressure are available. Objective To examine the relationship between intracranial pressure and specific nursing interventions observed during routine care. Methods Secondary analysis of prospectively collected observational data. Results During 3118 minutes of observation, 11 specific nursing interventions were observed for 28 nurse-patient dyads from 16 hospitals. Family members talking in the room, administering sedatives, and repositioning the patient were associated with a significantly lower intracranial pressure. However, intracranial pressure was sometimes higher, lower, or unchanged after each intervention observed. Conclusion Response of intracranial pressure to nursing interventions is inconsistent. Most interventions were associated with inconsistent changes in intracranial pressure at 1 or 5 minutes after the intervention.

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Section: Review Of Literaturementioning

confidence: 99%

Effects of Nursing Interventions on Intracranial Pressure

Olson

McNett

Lewis

et al. 2013

American Journal of Critical Care

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“…This study was designed to test the null hypothesis (chest percussion does not alter ICP) and to determine the safety of chest percussion when chest percussion was randomly assigned at a specific time of day. An earlier single-subject study 30 indicated a decrease in mean ICP during several episodes of chest percussion. The concept of chest percussion as a means of reducing ICP warrants further investigation.…”

Section: Discussionmentioning

confidence: 93%

Effect of Mechanical Chest Percussion on Intracranial Pressure: A Pilot Study

Olson

Thoyre

Bennett

et al. 2009

American Journal of Critical Care

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Background Treatment of brain injury is often focused on minimizing intracranial pressure, which, when elevated, can lead to secondary brain injury. Chest percussion is a common practice used to treat and prevent pneumonia. Conflicting and limited anecdotal evidence indicates that physical stimulation increases intracranial pressure and should be avoided in patients at risk of intracranial hypertension.Objectives To explore the safety of performing chest percussion for patients at high risk for intracranial hypertension.Methods A total of 28 patients with at least 1 documented episode of intracranial hypertension who were having intracranial pressure monitored were studied in a prospective randomized control trial. Patients were randomly assigned to either the control group (no chest percussion) or the intervention group (10 minutes of chest percussion at noon). Intracranial pressure was recorded once a minute before, during, and after the intervention.Results Mean intracranial pressures for the control group before, during, and after the study period (14.4, 15.0, and 15.9 mm Hg, respectively) did not differ significantly from pressures in the intervention group (13.6, 13.7, and 14.2 mm Hg, respectively).Conclusions Mechanical chest percussion may be a safe intervention for nurses to use on neurologically injured patients who are at risk for intracranial hypertension.

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“…Other types of auditory stimuli, including audio-taped recordings of messages and various sounds, however, have not been shown to produce significant increases in ICP (Johnson et al, 1989;Schinner et al, 1995;Treloar et al, 1991;Walker et al, 1998). The few studies on chest physiotherapy (Olson et al, 2007;Olson DM, 2009), a source of physical stimulation, have shown that this treatment does not significantly increase ICP. The studies described above demonstrate that the response to a presumed noxious stimulus is highly variable and the effect of oral care cannot be predicted from them.…”

Section: Nursing Interventions and Intracranial Pressurementioning

confidence: 99%

The Effect of Oral Care on Intracranial Pressure in Critically Ill Adults

Szabo

Grap

Munro

et al. 2014

Journal of Neuroscience Nursing

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A major goal in the care of patients with neurological problems is to prevent or minimize episodes of increased intracranial pressure (ICP). Elevations in ICP in response to nursing interventions have been acknowledged since the 1960s when ICP monitoring was first introduced in the clinical setting. Until recently, few studies have specifically examined the effect of oral care on ICP, and oral care and other hygiene measures were combined or not specified, prohibiting a direct interpretation of the influence of oral care alone on ICP. The purpose of this study was to describe the relationship between routine oral care interventions and the changes in ICP specifically focusing on the effect of intensity and duration of this intervention. Twenty-three patients with a clinical condition requiring ICP monitoring were enrolled over a 12-month period. Oral care provided by neuroscience intensive care nurses was observed and videotaped. Characteristics of the intervention were documented including products used, patient positioning, and duration of the intervention. A 1-5 subjective scale was used to score intensity of oral care. Wrist actigraphy data were collected from the nurses to provide an objective measure of intensity. Patient physiologic data were collected at 12-second epochs 5 minutes before, during, and 5 minutes after oral care. The mixed-effect repeated measures analysis of variance model indicated that there was a statistically significant increase in ICP in response to oral care (p = .0031). There was, however, no clinically significant effect on ICP. This study provides evidence that oral care is safe to perform in patients in the absence of preexisting elevated ICP.

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Changes in intracranial pressure associated with chest physiotherapy

Cited by 12 publications

References 14 publications

Effects of Nursing Interventions on Intracranial Pressure

Effects of Nursing Interventions on Intracranial Pressure

Effect of Mechanical Chest Percussion on Intracranial Pressure: A Pilot Study

The Effect of Oral Care on Intracranial Pressure in Critically Ill Adults

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