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* BACKGROUND Backrest positioning for brain-injured adults is variable. Some data support using a flat backrest to optimize cerebral perfusion pressure; other data support elevating the head of the bed at least 30 deg to reduce intracranial pressure.
* OBJECTiVE To determine whether a flat backrest position or a backrest elevation of 30 deg provides both optimal cerebral perfusion pressure and optimal intracranial pressure in adults with brain injuries.
* METHODS A randomized crossover experimental design was used to collect data on 8 adults 18 to 45 years old who had nonvascular, closed-head, traumatic brain injury. Repeated-measures multivariate analysis of variance was used to analyze the data.
* RESULTS Overall, compared with use of a flat/horizontal position, use of a backrest elevation of 30 deg resulted in significant and clinically important improvements in both intracranial and cerebral perfusion pressures. None of the subjects experienced adverse clinical changes in either intracranial pressure or cerebral perfusion pressure with either backrest position.
* CONCLUSION The results strengthen the research foundation for raising the backrest position for adults, 18 to 45 years old, who have nonvascular, nonpenetrating, severe brain injuries. (American Journal of Critical Care. 2000;9:373-382)
CE
Notice to CE enrollees:
A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
* Discuss the implications of prior research data on positioning with traumatic brain injury as related to the author's study.
* Compare and contrast the effects of flat and 30 deg backrest elevation positioning in traumatically brain-injured adults.
* Identify the nursing implications of the author's study related to the positioning of patients with traumatic brain injury.
Backrest positioning for severely brain-injured adults varies.1,2 Elevation of the head above the level of the heart reduces intracranial pressure (ICP) but may compromise cerebral perfusion pressure (CPP). Use of a flat position may improve CPP but lead to increased ICP Data support use of each position, yet even within studies,3-14 individual patients did not necessarily conform to the overall pattern of response. Because previous research on the safety and efficacy of backrest elevation in braininjured patients had conflicting results, the purpose of this study was to determine the effect of 2 backrest positions on ICP and CPP in adult patients with...