Dynamics of intracranial pressure, mean arterial pressure and cerebral perfusion pressure at change of head-of-bad position for patients with non-traumatic intracranial hemorrhages

Abstract

Introduction and purpose. Change of the «head-of-bed» position is a routine and simple method of correction of intracranial hypertension. There is still no consensus what exactly situation most effectively reduces intracranial pressure and doesn't compromise a cerebral blood flow. The purpose of the conducted research was the assessment influence of positioning on intracranial pressure and system hemodynamic at patients with a hemorrhagic stroke. Methods. 80 patients with a hemorrhagic stroke entered research. All of the patient carried out continuous monitoring of intracranial and system arterial pressure, transcranial doppler was daily carried out. To each patient was carried out «head-of-bed position» test (30°-0°-60°). Results. Despite various mechanism of hemorrhage in two studied groups in the first three days from the beginning of a disease similar tendencies to the progressing increase of intracranial pressure and decrease in mean arterial and cerebral perfusion pressure were observed. Only for the fifth days there were essential distinctions of the studied indicators. At consecutive «head-of-bed» changes are received the essential distinctions in the studied groups which aren't allowing to apply to them uniform algorithm of positioning. Conclusions. Positioning of patients with subarachnoid hemorrhages has no essential impact on the studied parameters. For patients with parenchymatous hemorrhages is preferable «head-of-bed» situation 30° and 60° the first and third day and 30° for the second and fifth day. Thus even short stay in horizontal position (0°) leads to the expressed growth of intracranial pressure and critical decrease in cerebral perfusion.