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

Abstract

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.

Effects of Nursing Interventions on Intracranial Pressure

“…[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.…”

“…Although some interventions are specifically targeted to reduce ICP, a variety of interventions may directly or indirectly affect ICP. [4][5][6][7] The impact of these interventions has not been well described. A few select studies [8][9][10] have been done to investigate statistical correlations between a specific intervention and ICP values.…”

Chest physiotherapy on intracranial pressure of critically ill patients admitted to the intensive care unit: a systematic review

“…(19,20,21,23) In addition, another included study did not report any significant differences after comparing the group of patients receiving the RP maneuvers with the control group without intervention. (22) None of the studies analyzed reported significant changes in CPP before, during and/or after the RP interventions.…”

“…Only one study (22) had a control group without intervention for comparison of the results; the remaining studies provided comparisons between periods (prior to, during and after the intervention). Four of the included studies only used a single intervention session.…”

Chest physiotherapy techniques in neurological intensive care units of India: A survey

“…[3] Chest physiotherapy has conflicting data about its effect on intracranial pressure (ICP) in neurological patients with head injury. [45] Mean arterial blood pressure (BP) and central venous pressure should be monitored in order to prevent adverse events such as autonomic dysreflexia or bradycardia in the patients admitted to the neurological ICU. Coughing can further increase the risk of re-bleed in patients with cerebral bleed.…”