Changes in intracranial pressure associated with chest physiotherapy

Abstract

Management of intracranial hypertension is pivotal in the care of brain-injured patients. We report the case of a patient with both a closed head injury and anoxic encephalopathy, who subsequently experienced episodes of refractory intracranial hypertension. The patient's care was complicated by the development of a pneumonia, which required frequent turning of the patient and chest physiotherapy. Conventional wisdom suggests that these interventions may stimulate the patient and worsen intracranial pressure, and therefore should be avoided. Our observations on this patient, however, contradict this belief. This single-subject study presents data to support the use of chest physiotherapy in patients at risk for intracranial hypertension. Further, the evidence is compelling that a randomized-controlled trial is indicated to test the hypothesis that chest physiotherapy may actually result in short-term resolution of high intracranial pressure, and thus provide one more clinical tool in the management of elevated intracranial pressure.