Far Eastern University Institute of Nursing Group 22 BSN 406

EBN
Alvarez, Ronel M. Celestial, Sharmaine Kaye B. Chua, Sheila May Sidney B. Crisostomo, Jessa Mae C. Cruz, Don Darryl G. De Guia, John Ronnel A. Del Mundo, Nina Renz Ivy C. Delgado, Arcel John A. Niu, Rachel T.

Brief Background

Introduction
I. Clinical Question
"What is the effect of Beach Chair positioning in patients with increase intracranial pressure and cerebral perfusion?"

Introduction
II. Citation
The effect of Beach Chair position on intracranial pressure and cerebral perfusion pressure in individuals with brain injury; A Systematic Review

III. Study Characteristics

PATIENTS INCLUDED
178 Participants 4-25 sample size with ages ranging from 7 to 83 years old, Patients with brain injury (severe head injury, decreased GCS usually lower than 8)

III. Study Characteristics

INTERVENTION COMPARED
Different Back Chair positioning 1) Elevated Head of Bed (30-60 degrees) 2) Reverse Trendelenburg 3) Flat on Bed

III. Study Characteristics

OUTCOMES MONITORED
Elevation of the head > Decrease in ICP Flat w/ no elevation > Maximum ICP

III. Study Characteristics

These studies are significant in improving quality care for neurologic patients. ICP and CPP are two of the most important vital signs in neurologic care. Proper positioning contributes in the care of patients with conditions/diseases that effect the brain.

IV. Methodology/Design
Methodology/Design/Setting
Descriptive / Quasi Experimental Design & Experimental Design / United States & Germany

IV. Methodology/Design
Subject Selection
3 Different Positions Cases of Brain injury, Hemorrhage, and Brain tumor Less than 18 months of age are excluded

IV. Methodology/Design
The study is not a replication, but based on the different articles, participants either experienced an improvement or a decrease in ICP & CPP.

IV. Methodology/Design
The intervention of positioning has its risks, head elevation may put the brain-injured individual at risk for secondary cerebral injury because of impaired arterial blood pressure and compromised CPP. There is a risk in harming the patient because of altered vitals signs and unexpected neurological accidents.

V. Results of the Study

Overall, the result of the study yields, a decrease in ICP for participants whose heads were elevated 30 degrees
30 degrees head elevation from the bed is what we call, Beach Chair Position of 30-60 degrees

Beach Chair Position

VI. Authors Conclusion/ Recommendations

The contribution of this study in the health status of future patients is that they can be treated effectively and decreasing the rate of mortality due to ICP. It can be a useful alternative in reducing ICP by a noninvasive physical intervention.

VI. Authors Conclusion/ Recommendations

It contributes to general nursing knowledge, that proper positioning treatment is a better alternative intervention to treat and reduce the pressure of ICP patients and it may decrease the amount of drugs that may be used for the treatment.

VII. Applicability
Yes it is a direct enough answer to our clinical question. Head elevation is a conventional nursing procedure for braininjured individuals with intracranial hypertension; it is performed with the intent of reducing ICP by means of a non-invasive physical intervention.

VII. Applicability
Yes, Beach chair positioning in patients with increased intracranial pressure is very feasible to be carried out in real world settings.

VII. Applicability
Theoretically the head is above the level of the heart on the vertical axis, and as a result, CSF is redistributed from the cranial to the spinal subarachnoid space (Kenning, Toutant, & Saunders, 1981), and it facilitates cerebral venous return (Magnaes, 1976; Magnaes, 1978; Marmarou, Shulman, & LaMorgese, 1975; Potts & Deonarine, 1973).