Cerebral Perfusion Pressure among Acute Traumatic Brain Injury Patients at Supine versus Semi-Fowler Positions

Abstract

Background: Positioning is one of the most frequently performed nursing activities in the intensive care units. However literature review documented lack of knowledge about the relationship of cerebral dynamics and different body positions among acute traumatic brain injury patients. Aim: the aim of this study is to  assess the effect of supine and semi-fowler position on cerebral perfusion pressure among patients with acute traumatic brain injuries at Cairo University Hospital as indicated by: Glasgow coma score (GCS), arterial blood gases values (ABG), oxygen saturation and vital signs (pulse, blood pressure and respiratory rate). Research questions: What is the effect of supine position on cerebral perfusion pressure among patients with acute traumatic brain injuries? And what is the effect of semi fowler position on cerebral perfusion pressure among patients with acute traumatic brain injuries? Sample: Convenience sample of 39 patients admitted with acute traumatic brain injury. Design: Descriptive exploratory repeated measures study. Setting: University Hospital in Cairo. Tools: Initial acute traumatic brain injury patient’s assessment sheet, and cerebral oxygenation and physiological parameters assessment sheet for acute traumatic brain injury patients. Result: The mean age was 28.5 ±7.9 years. (74.4%) have normal body weight, (25.6%) were having cerebral contusion. Significant increase of CPP, Pao2, SaO2, SPO2, mean arterial pressure and systolic blood pressure, in 15 min post semi-fowler position assessment with a significant decrease of PaCo2. Significant decrease of pulse rate in supine position was evident. With no significant changes in diastolic blood pressure and GCS. Conclusion: Semi-fowler position was found to affect the ABG values, mean arterial pressure, respiratory rate, SpO2 and CPP positively.  Recommendation: Studying the effect of side lying and prone position to establish data base about the optimal body position for acute traumatic head injury patients is highly recommended with replication of this study on larger probability sample.

Key words: supine position, semi-fowler position, physiological parameters, cerebral perfusion pressure, acute traumatic brain injury.