Management of Raised Inracranial Pressure

I just want to have a debate or possible critic views upon physiotherapy management of raised intracranial pressure. The management is important in the head injury patient. As the possible management is the treatment of any underlying cause responsible for raised intracranial pressure like mangement of any skull fracture, in case of threatening haemorrhage is to treat that, if there is tumour possible surgery to treat that.

The Head down position impair the venous return from the head (70% blood volume intracranially is in the venous section of the vascular bed) and will result in raised intracranial pressure. The bed end should be raised 30 degree and the head maintained in the midline is the best position tp prevent kinking of major arteries in the neck to aid venour drainage and reduce ICP.

ICP can also be controlled by hyperventilation to lower the arterial carbon dioxide level (Pa CO2). A raised PaCo2 causes vasodilatation and an increase in ICP, while lowering the PaCO2 causes vasoconstriction of the cerebral arterioles and decreases the ICP.

Manual hyperinflation produce hyperventilation which lowers the PaCO2 and lowers the ICP.

The removal of any secretions and re expansion of collapsed lung tissue will also lower the Pa CO2 and hence lower the raised ICP.

Please, make possible suggestions and your comments and experiences regarding the physiotherapy management of raised ICP.