Evaluation of the effects of physiotherapy on intracranial pressure in intensive care patients by ultrasonographic optic nerve sheats diameter measurement

• Published in: Journal of critical care 2024-06, Vol.81, p.154632, Article 154632
• Main Authors: Kucuk, Ahmet Oguzhan, Hatinoglu, Neslihan, Apaydın, Umut, Altunalan, Turgay, Kucuk, Mehtap Pehlivanlar
• Format: Article
• Language: English
• Subjects: Intensive care; Intensive care medicine; Intracranial pressure; Optic nerve sheath diameter; Ostomy; Physiotherapy; Range of motion; Rehabilitation; Ventilators
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2024.154632

In this study, it was aimed to determine whether routine physiotherapy exercises effect intracranial pressure in intensive care patients on mechanical ventilation, with optic nerve sheats diameter measurement (OSC), which is a bedside noninvasive technique. This study was planned prospectively in the 3rd step intensive care unit of our faculty hospital. Only clinically stable patients who were intubated and followed on a mechanical ventilator included to the study. Passive range of motion will be applied once a day, starting from the day of hospitalization, as part of treatment by physiotherapist. Optic nerve sheath diameter measurements will be made before, during and 10 min after physiotherapy. During a four-month period, 142 patients admitted to the intensive care unit were evaluated and 20 eligible patients were included in the study, (Fig. 1) The median age of the patients included in the study was 65 years and 9 (45%) of them were female. The most common primary hospitalization diagnosis was pulmonary origin. The most common comorbidity was hypertension. All patients were intubated and the median intensive care unit (ICU) APACHE score was 21. Demographic information of the patients is given in Table 1. Vasopressor was started in 13 patients (65%) for any reason. The mean sedation doses, vasopressor doses and outcome status of the patients during hospitalization are given in Table 1. Measurements performed at the beginning, middle and end of ROM exercises are shown in Table 2. The analyses showed that there was no statistically significant change in optic nerve sheath diameter during or after the procedure compared to before the procedure. Similarly, it was determined that there was no statistically significant change in haemodynamic parameters in the middle and at the end of the procedure compared to before the procedure. (Table 2, Fig. 2, 3) This study provides evidence that daily extremity physiotherapy exercises can be safely applied without causing increased intracranial pressure or hemodynamic instability in intensive care patients followed up on mechanical ventilation including patients vassopressor therapy.