Effects of Positioning and Exercise on Intracranial Pressure in a Neurosurgical Intensive Care Unit

Brimioulle, Serge; Moraine, Jean-Jacques; Norrenberg, Danielle; Kahn, Robert J.

doi:10.1093/ptj/77.12.1682

Cited by 64 publications

(58 citation statements)

References 3 publications

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“…The variables assessed to evaluate the integrity of dynamic cerebral autoregulation-the LF gain between BP and CBFV oscillations and the phase shift between BP and CBFV oscillations-demonstrated that dynamic cerebral autoregulation remained stable during increasing levels of physical exercise despite the autonomic, mechanical, and metabolic effects of increasing physical effort (7,15,24,28,32,35,41,50,53). In our study, not only did the absolute gain remain stable but we also observed no change in normalized LF gain value.…”

Section: Discussionsupporting

confidence: 42%

Dynamic cerebral autoregulation remains stable during physical challenge in healthy persons

Bryś

Brown²,

Marthol³

et al. 2003

American Journal of Physiology-Heart and Circulatory Physiology

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. Dynamic cerebral autoregulation remains stable during physical challenge in healthy persons. Am J Physiol Heart Circ Physiol 285: H1048-H1054, 2003; 10.1152/ajpheart.00062.2003.-The effects of physical activity on cerebral blood flow (CBF) and cerebral autoregulation (CA) have not yet been fully evaluated. There is controversy as to whether increasing heart rate (HR), blood pressure (BP), and sympathetic and metabolic activity with altered levels of CO2 might compromise CBF and CA. To evaluate these effects, we studied middle cerebral artery blood flow velocity (CBFV) and CA in 40 healthy young adults at rest and during increasing levels of physical exercise. We continuously monitored HR, BP, endexpiratory CO 2, and CBFV with transcranial Doppler sonography at rest and during stepwise ergometric challenge at 50, 100, and 150 W. The modulation of BP and CBFV in the low-frequency (LF) range (0.04-0.14 Hz) was calculated with an autoregression algorithm. CA was evaluated by calculating the phase shift angle and gain between BP and CBFV oscillations in the LF range. The LF BP-CBFV gain was then normalized by conductance. Cerebrovascular resistance (CVR) was calculated as mean BP adjusted to brain level divided by mean CBFV. HR, BP, CO 2, and CBFV increased significantly with exercise. Phase shift angle, absolute and normalized LF BP-CBFV gain, and CVR, however, remained stable. Stable phase shift, LF BP-CBFV gain, and CVR demonstrate that progressive physical exercise does not alter CA despite increasing HR, BP, and CO 2. CA seems to compensate for the hemodynamic effects and increasing CO2 levels during exercise.cross-spectral analysis; low-frequency blood pressure-cerebral blood flow velocity gain; phase shift angle; cerebrovascular resistance CEREBRAL AUTOREGULATION normally ensures that cerebral blood flow (CBF) remains relatively constant despite fluctuations in blood pressure (BP), provided that mean BP remains within the range of autoregulation, usually from 50 to 170 mmHg (6,21,37). If BP exceeds these limits, CBF increases, initially in a curvilinear relation, and then follows BP passively in a linear relation (21, 31). During increasing levels of physical effort, cerebral perfusion is not only driven by increasing BP and heart rate (HR) but also has to adjust to high levels of sympathetic activity and to altered metabolism with changes in PO 2 and PCO 2 . With increasing muscle metabolism, PO 2 in the blood decreases, whereas PCO 2 increases, unless augmented respiration compensates for the higher O 2 demand and production of CO 2 (17,35,54). Cerebral autoregulation has to counterbalance all the cardiovascular and metabolic responses to physical effort. Although some studies suggest that CBF velocity (CBFV) and CBF remain stable despite physical effort (15), several others found an increase in CBFV (14, 17, 30) as well as regional CBF (10, 55) and global CBF during exercise (24, 51).During cardiovascular changes as they occur with increasing physical challenge, cerebral autoregulation can be evaluated b...

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Section: Discussionsupporting

confidence: 42%

Dynamic cerebral autoregulation remains stable during physical challenge in healthy persons

Bryś

Brown²,

Marthol³

et al. 2003

American Journal of Physiology-Heart and Circulatory Physiology

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“…[1][2][3][4][5] Improved cardiopulmonary function, functional independence, and psychological well-being, as well as decreased length of stay, have been associated with early mobilization in the ICU. 1,[6][7][8] The negative effects of inactivity, such as increased depression, lack of coordination, decreased muscle strength, altered balance, and decreased cardiovascular and respiratory status, have also been well established in the literature for a variety of populations within acute care settings. 1,[6][7][8] The use of an external ventricular drain (EVD) to manage intracranial pressure (ICP) dates back to 1850 and is the most common neurosurgical procedure in North America; an estimated 20,000 are performed each year in the United States alone.…”

mentioning

confidence: 99%

“…1,[6][7][8] The negative effects of inactivity, such as increased depression, lack of coordination, decreased muscle strength, altered balance, and decreased cardiovascular and respiratory status, have also been well established in the literature for a variety of populations within acute care settings. 1,[6][7][8] The use of an external ventricular drain (EVD) to manage intracranial pressure (ICP) dates back to 1850 and is the most common neurosurgical procedure in North America; an estimated 20,000 are performed each year in the United States alone. 9-11 (Canadian statistics for this procedure have not been identified in the literature.)…”

mentioning

confidence: 99%

Practice Patterns of Canadian Physiotherapists Mobilizing Patients with External Ventricular Drains

Hale

Wong

Pennings

et al. 2013

Physiotherapy Canada

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Purpose: To describe current mobilization practices of Canadian physiotherapists when treating patients with external ventricular drains (EVDs). Methods: A quantitative, descriptive, cross-sectional study design using an online questionnaire via SurveyMonkey. An email invitation and questionnaire link was distributed in March 2010 to physiotherapists currently working with this patient population in Neurosurgical Centres across Canada. Results: Respondents were 25 physiotherapists (21 full-time, 2 part-time, and 2 who did not disclose work status) working in 5 different provinces who treated b1 patient/ month with an EVD (n ¼ 9). Slightly more than half of respondents had a10 years' clinical physiotherapy experience (n ¼ 14); the remainder had >10 years' experience (n ¼ 11). The majority of respondents indicated that they felt comfortable mobilizing patients with EVDs (n ¼ 19) and that it was safe to do so (n ¼ 20). Clinical experience (n ¼ 23) and safety concerns (n ¼ 25) were most commonly cited as guiding practice. More experienced physiotherapists were more likely to use out-of-bed mobilization practices. Regardless of experience, the majority of physiotherapists (20/25) ranked intracranial pressure (ICP) as the most important factor and saturation of oxygen (Spo 2 ) as the least important factor to consider before mobilization. Conclusions: Canadian physiotherapists are mobilizing patients with EVDs, and the intensity level of their mobilization practices appears to be related to their experience level. Data from the current study may be used in developing future best-practice guidelines for the mobilization of patients with EVDs.Key Words: clinical experience; clinical reasoning; external ventricular drain; mobilization. RÉ SUMÉObjectif : Dé crire les mé thodes actuelles de mobilisation pratiqué es par les physiothé rapeutes canadiens qui traitent des patients avec des drains ventriculaires externes (DVE). Mé thodes : É tude transversale descriptive quantitative basé e sur un questionnaire en ligne administré via SurveyMonkey. Une invitation é lectronique comportant un lien vers le questionnaire a é té distribué e en mars 2010 aux physiothé rapeutes qui travaillent actuellement avec cette population dans les centres de neurochirurgie du Canada. Ré sultats : Les ré pondants é taient 25 physiothé rapeutes travaillant (21 à temps plein, 2 à temps partiel, 2 qui n'ont pas ré vé lé leur statut) dans cinq provinces diffé rentes qui ont traité b1 patient/mois au moyen de DVE (n ¼ 9). Un peu plus de la moitié des ré pondants comptaient a10 ans d'expé rience de la physiothé rapie clinique (n ¼ 14); les autres en comptaient >10 (n ¼ 11). La majorité des ré pondants ont indiqué se sentir à l'aise de mobiliser cette population (n ¼ 19) et qu'il é tait sé curitaire de le faire (n ¼ 20). L'expé rience clinique (n ¼ 23) et les pré occupations en matiè re de sé curité (n ¼ 25) ont é té les facteurs mentionné s le plus souvent comme guide de pratique. La plupart des physiothé rapeutes chevronné s é taient plus susc...

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“…Exitem poucos trabalhos na literatura que avaliam esse assunto, porém todos acharam que a fisioterapia causa pequeno e temporário aumento da PIC, sem alteração de PPC. Portanto, as manobras de fisioterapia podem ser aplicadas em pacientes com TCE com segurança [15][16][17][18] .…”

Section: Resultsunclassified

Influência da fisioterapia respiratória na pressão intracraniana em pacientes com traumatismo craniencefálico grave

Thiesen

Dragosavac

Roquejani

et al. 2005

Arq. Neuro-Psiquiatr.

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RESUMO -O b j e t i v o:Estudar a influência das manobras de fisioterapia respiratória na pressão intracraniana (PIC) dos pacientes com trauma craniencefálico grave. Método: Trinta e cinco pacientes com trauma craniencefálico grave foram incluídos no estudo, sendo divididos em três grupos: com PIC < 10, 11-20 e 21-30 mmHg. As variáveis monitorizadas foram: PIC e pressão arterial média. A pressão de perfusão cerebral foi calculada pela diferença de pressão arterial média e PIC. Resultados: A manobra de aspiração traqueal causou aumento de PIC em todos os grupos. A pressão arterial média não teve alterações e a pressão de perfusão cerebral diminuiu pouco, porém mantendo valores normais. Conclusão: As manobras de fisioterapia respiratória podem ser usadas com segurança em pacientes com traumatismo craniencefálico grave, com PIC abaixo de 30 mmHg.Certo cuidado deve ser tomado durante a aspiração traqueal.PALAVRAS-CHAVE: traumatismo craniencefálico, fisioterapia respiratória, pressão intracraniana, pressão de perfusão cerebral.Influence of the respiratory physioterapy on intracranial pre s s u re in severe head trauma patients ABSTRACT -O b j e c t i v e:To evaluate influence of the respiratory physiotherapy on intracranial pressure (ICP) in patients with severe head trauma. M e t h o d: Thirty five patients with severe head trauma were included in the study.The patients were divided into three groups: ICP 0-10, 11-20 and 21-30 mmHg. The following variables were measured: ICP and mean arterial pressure. Cerebral perfusion pressure was calculated as the difference between mean arterial and intracranial pressure. R e s u l t s: Endotracheal aspiration increased ICP in all patients. The mean arterial pressure didn't change and cerebral perfusion pressure decreased, but remaning normal value. Conclusion: Respiratory physiotherapy maneuvers can be safely applied in patients with severe head trauma with ICP below 30 mmHg. More attention should be taken during endotracheal aspiration .KEY WORDS: head injury, respiratory physioterapy, intracranial pressure, cerebral perfusion pressure.Os pacientes com traumatismo craniencefálico (TCE) grave, com escala de coma de Glasgow igual ou menor que 8, são geralmente submetidos à monitorização da pressão intracraniana (PIC), e da pressão arterial média (PAM) e tratados de acordo c o m um protocolo rígido de assistência, que inclui sedação, elevação de cabeceira do leito, ventilação mecânica otimizada, fisioterapia respiratória e motora, entre outras 1 , 2 . A aplicação das manobras cinéticas de fisioterapia respiratória promove aumento momentâneo da pressão intratorácica, diminuindo o retorno venoso cerebral e elevando a PIC nesses p acientes [3][4][5][6] .Sabe-se que as alterações da PIC influenciam diretamente a pressão de perfusão cerebral (PPC), que é calculada como diferença entre a PAM e a PIC. Portanto, aumentos da PIC poderiam acarretar diminuição da PPC, se não houver aumento conco-

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Effects of Positioning and Exercise on Intracranial Pressure in a Neurosurgical Intensive Care Unit

Abstract: Physical therapy can be used safely in patients with normal or increased ICP provided that Valsalva-like maneuvers are avoided. [Brimioulle S, Moraine J-J, Norrenberg D, Kahn RJ. Effects of positioning and exercise on intracranial pressure in a neurosurgical intensive care unit.

Cited by 64 publications

References 3 publications

Dynamic cerebral autoregulation remains stable during physical challenge in healthy persons

Dynamic cerebral autoregulation remains stable during physical challenge in healthy persons

Practice Patterns of Canadian Physiotherapists Mobilizing Patients with External Ventricular Drains

Influência da fisioterapia respiratória na pressão intracraniana em pacientes com traumatismo craniencefálico grave

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