Changes In Intracranial Pressure in Patients with External Ventricular Drainage of CSF During Nursing Interventions

Abstract

Introduction. When managing intracranial pressure (ICP) disorders, that is, deviations from the normal value (5 - 15 mmHg), it helps to understand the variability of cerebral blood volume and cerebrospinal fluid. Aim. To explore from a series of cases the impact of nursing interventions on the increase of intracranial pressure and the possibility of preventive action on possible oscillations of measured pressure values by modifying sedation and analgesia in order to avoid potentially negative effects on brain injury. Methods. The study included six patients, with the average age of 59 years, hospitalized between December 2018 and May 2019, on whom measurements were performed before, immediately after and 30 minutes after the end of a particular intervention using an external drainage and monitoring system. Intracranial pressures of patients in an induced coma were compared with those who were in a natural coma. Results. During morning nursing care and aspiration of secretions, an increase in the mean value of ICP was observed immediately after the intervention, but the t-test for dependent samples showed that it was not statistically significant, while in massaging patients with turning it to the side it was statistically significant. Combining all interventions into one, without categorization, there was also a statistically significant increase in intracranial pressure immediately upon completion of morning nursing care. After 30 minutes, the pressure values in all interventions approach the initial value and remain within the deviation of 1 mmHg. Conclusion. Most nursing interventions are associated with a slight increase in ICP that is not statistically significant. Greater oscillations were observed in patients in an induced coma than in those in a natural coma, which could probably have been avoided by even stricter titration of analgosedation immediately before and during nursing interventions.