Intracranial pressure changes during pulmonary expansion maneuver in patients with severe traumatic brain injury, monitored at the unity of intensive therapy

Abstract

In physical therapy, there are specific means available for rehabilitation in the ICU, as well as for patients with severe traumatic brain injury (TBI). Among the available techniques, the pulmonary expansion maneuver, a kinesiotherapy technique aimed at mobilizing lung secretions, preventing and treating atelectasis.Model of the study: The study was classified as field research (experimental), based on assessment of the ICP during and after pulmonary expansion maneuver. Objective: To verify how the pulmonary expansion therapy affects intracranial pressure (ICP) in patients with severe TBI. Methodology: The study was approved by the Ethics and Research Committee of the PUCPR (opinion 1455). It was carried out at the unity of intensive therapy (ICU) in the Cajuru University Hospital, Curitiba-PR. Fifteen severe TBI patients of both genders participated in the study, their ages ranging between 18 and 50 years. The monitored variables were ICP, mean arterial pressure (MAP) and brain perfusion pressure (BPP). Results: During the application of the research protocol it was observed that MAP and the BPP remained within or close to normal range with slight changes, while ICP increased approximately 1 mmHg then returning to baseline values. Mean ICP in the 1st, 2nd and 3rd days were 5,42 (±4,69) mmHg, 6,71 (±6,84) mmHg and 5,60 (±4,33) mmHg with statistical significance of p<0,001, p=0,008 and p=0,001 respectively. Conclusions: The pulmonary expansion maneuver may be performed in severe TBI patients who are hemodynamically stable and have a baseline ICP below 20 mmHg.