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

Objective

To evaluate the effects of respiratory physiotherapy and passive mobilization on intracranial pressure (ICP) and cerebral perfusion pressure (CPP).

Methods

Sixty patients with traumatic brain injury (TBI) with Glasgow Coma Scale (GSC) ≤ 8 and normal ICP and CPP were evaluated. A 30° head-up position was used during the study. ICP and CPP were monitored during the following procedures: chest compression, vibration associated with chest compression, unilateral continuous chest compression, tracheal suction with open circuit and closed circuit, passive mobilization of arms and legs, hip rotation, scapular mobilization in lateral decubitus and lateral flexion of the lower trunk. The procedures were interrupted when the ICP and CPP reached 20 mmHg and 70 mmHg, respectively. The Wilcoxon test was used to evaluate changes in ICP during the procedures. The MacNemar test was used to verify the rate of patients that reached ICP and CPP of 20 mmHg and 70 mmHg, respectively.

Results

Initial ICP and CPP were 12.1 ± 2.6 mmHg and 87 ± 8.3 mmHg, respectively. Four procedures changed ICP and CPP significantly: lateral flexion of the lower trunk (17.4 ± 2.5 mmHg and 81.7 ± 8.1 mmHg, respectively; P = 0.0001), unilateral continuous chest compression (17.2 ± 2.6 mmHg and 81.9 ± 8.3 mmHg, respectively; P = 0.0001), tracheal suction with open circuit (17.7 ± 2.5 mmHg and 81.4 ± 8.2 mmHg, respectively; P = 0.0001) and tracheal suction with closed circuit (16.2 ± 2.2 mmHg and 82.9 ± 7.9 mmHg, respectively; P = 0.0001). Continuous chest compression, tracheal suction with open circuit and lateral flexion of the lower trunk frequently reached ICP of 20 mmHg (13.3%, P = 0.013; 20%, P = 0.0014; and 16.7%, P = 0.004, respectively). Tracheal suction with closed circuit did not reach ICP of 20 mmHg.

Conclusion

Unilateral continuous chest compression and lateral flexion of the lower trunk should be avoided in the acute phase of TBI patients. Tracheal suction is unavoidable, but should be done carefully and preferably with a closed circuit.