Intracranial pressure changes during positioning of patients with severe head injury.

To understand the effect of positioning of patients on intracranial pressure, studies were performed in 30 patients with head injuries severe enough to produce prolonged coma with Glasgow Coma Scale scores less than 8. Intracranial pressure was measured with the patient in four different positions: head at 0 degrees, head down 30 degrees, three fourths supine, and three fourths prone without turning the head. Intracranial pressure results were as follows: at 0 degrees, 20.50 +/- 1.75 (mean +/- SEM) mm Hg; head down 30 degrees, 24.15 +/- 1.75 mm Hg; three fourths supine, 28.83 +/- 2.69 mm Hg; and three fourths prone 30.85 +/- 2.90 mm Hg. Intracranial pressures were higher in the latter three positions as compared with the standard 0 degrees supine position, but some individual differences in response were noted. The data suggest that the head-down, three-fourths supine, and three-fourths prone positions have a greater chance of increasing the intracranial pressure in patients with severe head injury having prolonged comas. When patients are placed in the above three postures the duration should be as short as possible, and they should be used only when absolutely necessary.