Effect of continuous rotational therapy on intracranial pressure in the severely brain-injured patient.

Objective: To determine the effect of continuous rotational therapy on the dynamics of intracranial pressure.
Design: A controlled, prospective evaluation of intracranial pressure during continuous rotation therapy.
Setting: Neuroscience intensive care unit in a university hospital.
Patients: A total of 58 severely brain-injured patients (Glasgow Coma Score of < or = 9) ranging in age from 14 to 81 yrs.
Interventions: All patients had intraventricular catheters placed to continuously monitor intracranial pressure and all patients were placed on continuous rotational therapy once stabilized.
Measurements and Main Results: Intracranial pressure data were measured in each patient during nonrotation and these data were compared with intracranial pressure data during rotation, thus allowing each patient to serve as their own control. In addition, the intracranial pressure during rotation (40 degrees from center) was further analyzed to determine the effect of angulation on the intracranial pressure. Analysis of computer-recorded intracranial pressure data showed no significant difference in intracranial pressure measured during rotation and nonrotation over the first 5 days postinjury. Minimal differences in intracranial pressure (< 1 to 2 mm Hg) were noted in right/center/left positions. It was also determined that intracranial pressure increased up to 6.5 mm Hg (p = .12) in patients who presented with a unilateral lesion on admission computed tomography when they rotated to the side of the lesion. However, these fluctuations did not promote additional intracranial pressure management.
Conclusions: We conclude that the systemic benefits known to be derived from the use of continuous rotation therapy in the severely head-injured patient can be sustained without any deleterious effects on the intracranial pressure.