Nursing Interventions and Intracranial Pressure Change in Pediatric Patients With Severe Traumatic Brain Injury.

Abstract

Background: Nursing interventions in the care of pediatric patients with severe traumatic brain injury (TBI) can have a direct effect on intracranial pressure (ICP), yet they have been largely underexplored. Early evidence is therefore needed to describe these relationships and to determine intervention that promotes neuroprotection and recovery.

Objectives: The aim of this study was to examine nursing interventions within the first 72 hours of pediatric severe TBI and their effects on ICP.

Method: This is a retrospective review of pediatric patients admitted for severe TBI using a quasi-experimental approach to assess nursing interventions and their association with the patients' ICP values prior to and after each intervention.

Results: Of the 56 patients who met the inclusion criteria, 3392 intervention events (range, 31-138 events per patient) were reported. Paired t tests conducted for each intervention type found a statistically significant relationship with suctioning and percent change in ICP values (P = .045). All other interventions showed no significant differences.

Discussion: Standard nursing interventions, specifically suctioning, in pediatric severe TBI may affect ICP and therefore neuroprotection. Further work is needed to better understand the role and timing of nursing interventions and their influence on cerebral hemodynamics so that future TBI guidelines consider nursing care and their impact on brain injury recovery.