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

Abstract

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 study was undertaken to clarify the issue of optimal head position in the care of head-injured patients. The effect of 0 degree and 30 degrees head elevation on ICP, CPP, CBF, mean carotid pressure, and other cerebral and systemic physiological parameters was studied in 22 head-injured patients. The mean carotid pressure was significantly lower when the patient's head was elevated at 30 degrees than at 0 degrees (84.3 +/- 14.5 mm Hg vs. 89.5 +/- 14.6 mm Hg), as was the mean ICP (14.1 +/- 6.7 mm Hg vs. 19.7 +/- 8.3 mm Hg). There was no statistically significant change in CPP, CBF, cerebral metabolic rate of oxygen, arteriovenous difference of lactate, or cerebrovascular resistance associated with the change in head position. The data indicate that head elevation to 30 degrees significantly reduced ICP in the majority of the 22 patients without reducing CPP or CBF.

Intracranial pressure pulse amplitude during changes in head elevation: a new parameter for determining optimum cerebral perfusion pressure?

“…However, 13 patients showed lower ICPPA values at 0°position. The 30°head-up position is often used intuitively, and it was shown to be associated with low ICP and improved cerebral oxygenation in several studies [13,16,23,29,33,34,40,53]. However, all these studies also showed a considerable individual variability in terms of the optimum level of head elevation.…”

“…The results of a study by Feldman et al [16] suggested that head-injured patients with raised ICP should be positioned with the head elevated to 30°. This will produce a reduction of the ICP without a significant decrease in cerebral blood flow (CBF) or CPP in the majority of measured patients.…”

Traumatic Brain Injury: Current Treatment Strategies and Future Endeavors

“…136 It has also been reported that visually defected rats may regain some degree of visual acuity after exposure to an EE. 17 The prophylactic effects of EE exposure prior to undergoing a TBI has also shown positive results. 137 Spinal cord-injured rats also display functional recovery once exposed to an EE.…”

Head elevation reduces head-rotation associated increased ICP in patients with intracranial tumours

“…10,11 Head elevation augments venous drainage of the head and reduces ICP in the ICU setting. [4][5][6][7][8][9] Enhanced venous drainage induced by head elevation may off-set the effect of impaired venous drainage caused by head rotation resulting in a reduced risk for intracranial hypertension.…”

“…Head elevation lowers ICP 2,3 and reduces intracranial hypertension secondary to trauma and intracranial hemorrhage in the ICU setting. [4][5][6][7][8][9] Head rotation increases ICP by impeding venous drainage of the head in adults 10,11 and infants. 1 3 The increase in ICP associated with head rotation in infants was reduced by concomitant head elevation.…”