Effects of chest physiotherapy and passive mobilization on intracranial pressure and cerebral perfusion pressure in traumatic brain injury patients

Abstract

Introduction Many authors have written about the need to treat patients closer to their beds, in order to observe them more as distinct people. The FAST HUG mnemonic, which consists of a checklist, was suggested as an idea to be employed everyday, by professionals dealing with patients who are critically ill. Minding these questions and motivated by an idea of follow patients' treatment closer, we have put into practice the instrument developed by Jean-Louis Vincent, evaluating the seven most important procedures in critically ill patients, and performed the FAST HUG. This checklist consists of seven items to be evaluated: Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glucose control. Knowing that the pressure ulcer is one of the challenges faced by ICU nurses, related to patients' need to stay at rest, to be under rigorous control or more complex therapy, it was decided to create the eighth item on the checklist: S, for skin. It stands for skin treatment, with the techniques used in the unit (Braden Scale), monitoring and evaluating closer skin integrity, and allowing nurses to calculate the scoring average of the Braden Scale, and greater incidence of ulcer in interned patients. Objective To expose the shortcomings found during the FAST HUG application, and to show results obtained with the eighth item of the FAST HUG mnemonic: S-Skin. Methods A descriptive study, based on institutional data, was carried out in the adult ICU of a private hospital. It was performed from 2 to 27 June 2008, except on weekends. Three hundred and twenty-three patients were involved. The checklist was carried out during the afternoons by the head nurse, or the assistant nurse of the unit. In order to do this job, a spreadsheet was elaborated to control data, updated every week. This spreadsheet provided graphics for a more objective control of the results obtained. The idea was exposed to the team, during a training program, and so we started the activities. Results and discussion For 20 days of the checklist, 323 patients were evaluated for the eight items. The real shortcomings most frequently found were related to thromboembolic prophylaxis (85%) and glucose control (90%). These shortcomings were immediately evaluated and, depending on this analysis, this item would go on or not, according to the patient's clinical situation. The shortcomings found were tracked just as they were detected, and their cause would be discussed in a multidisciplinary group, and a solution was found. If the item was not observed, it would be 1. Vincent JL: Give your patient a fast hug (at least) once a day.

Effects of Open and Closed Endotracheal Suctioning on Intracranial Pressure and Cerebral Perfusion Pressure in Adult Patients With Severe Brain Injury

“…Fourteen items were included in this review: two systematic reviews (Heluain et al, 2011;Tume & Jinks, 2008), two nonrandomized prospective clinical trials (Cerqueira-Neto et al, 2010;Gemma et al, 2002), two prospective double-blind clinical trials (Bilotta et al, 2008;Mathieu et al, 2013), one single-blind crossover clinical trial (U?raz & Aksoy, 2012), three prospective interventional case studies (Leone et al, 2004;Murillo et al, 2002;Thiesen et al, 2005), one case-control study (Chivite Fernàndez et al, 2005), and three observational studies (Gholamzadeh & Javadi, 2009;Hickey et al, 2009;Nemer et al, 2009).…”

“…Four studies involved ventilated patients in a neurosurgical intensive care unit (Bilotta et al, 2008;Hickey et al, 2009;Mathieu et al, 2013;U?raz & Aksoy, 2012), and the remaining articles were conducted in general adult intensive care units. Three studies were carried out in the context of other treatments, such as chest physiotherapy (Cerquiera-Neto, 2010; Nemer et al, 2009;Thiesen et al, 2005). Both…”

“…However, Gemma et al (2002) suggest that CPP decreases in patients who move or experience the cough reflex during OSS, whereas CPP increases well in sedated patients (mean change of j7 T 15 vs. 14 T 5 mm Hg, p G .0001). According to Nemer et al (2009) Evidence shows that, after both OSS and CSS, the parameters can take up to 10 minutes to return to baseline levels; thus, it should be recommended to nurses to leave an interval of at least 10 minutes after completing the procedure before repeating it (Cerqueira-Neto et al, 2010;Hickey et al, 2009;Murillo et al, 2002). Although many drugs, including muscle relaxants (Leone et al, 2004), local anesthetics such as lidocaine (Bilotta et al, 2008;Mathieu et al, 2013), and opioids (Chivite Fernàndez et al, 2005), have been proposed for use during endotracheal suctioning in patients with severe brain injury to prevent intracranial hypertension, their application has not always been possible in the clinical field.…”

“…Currently, there are two methods of endotracheal suctioning: open system suctioning (OSS) and closed system suctioning (CSS). The first requires disconnecting the patient's ventilator before performing the aspiration procedure, whereas the second does not (Nemer et al, 2009;U?raz & Aksoy, 2012).…”