PICU, Alder Hey Children's NHS Foundation Trust/Liverpool John Moores University, Liverpool, UK.
Nurs Crit Care. 2011 Mar-Apr;16(2):77-84. doi: 10.1111/j.1478-5153.2010.00412.x.
The aim of this research was to investigate the effect of five selected intensive care nursing interventions on the intracranial pressure (ICP) of moderate to severe traumatic brain-injured children in intensive care.
The physiological effects of many nursing interventions in paediatric intensive care (PIC) are not known. This results in the lack of an evidence base for many PIC nursing practices.
Prospective observational cohort study conducted over 3 years in a single tertiary referral paediatric intensive care unit (PICU) in the North West of England.
Five selected commonly performed nursing interventions were studied: endotracheal suctioning and manual ventilation (ETSMV), turning via a log-rolling (LR) approach, eye care, oral care and washing. These were studied in the first 72 h after injury.
A total of 25 children with moderate to severe traumatic brain injury and intraparenchymal ICP monitoring in intensive care (aged 2-17 years) were enrolled. Both ETSMV and LR were associated with clinically and statistically significant changes in ICP from baseline to maximal ICP (p = 0·001 ETSMV; p = < 0·001 LR) and from maximal post-ICP (p = < 0·001 ETSMV; p = < 0.001 LR). Eye care, oral care or washing did not cause any clinically significant change in ICP from baseline. After decompressive craniectomy, none of the interventions caused significant changes in ICP.
Only two of the five nursing interventions, endotracheal suctioning and LR, caused intracranial hypertension in moderate to severe traumatic brain-injured children, and after craniectomy, no care interventions caused any significant change in ICP.
Knowledge about the physiological effects of many intensive care nursing interventions is lacking and this is magnified in paediatrics. This study provides a significant addition to the evidence base in this area and allows intensive care nurses to plan, implement and evaluate more effectively their nursing care for brain-injured children.
本研究旨在探讨五项精选的重症监护护理干预措施对重症颅脑损伤儿童颅内压（ICP）的影响。
儿科重症监护（PIC）中许多护理干预措施的生理效应尚不清楚。这导致了许多 PIC 护理实践缺乏循证基础。
在英格兰西北部的一家单一的三级转诊儿科重症监护病房（PICU）进行了为期 3 年的前瞻性观察队列研究。
研究了五项常见的护理干预措施：经气管吸引和手动通气（ETSMV）、采用侧卧滚动（LR）的翻身、眼部护理、口腔护理和清洗。这些干预措施在损伤后的前 72 小时内进行研究。
共纳入 25 名在重症监护中患有中重度颅脑损伤和脑实质 ICP 监测的儿童（年龄 2-17 岁）。ETSMV 和 LR 均与 ICP 从基线到最大 ICP 的临床和统计学显著变化相关（p = 0.001 ETSMV；p < 0.001 LR），以及从最大 ICP 后到 ICP 的变化相关（p < 0.001 ETSMV；p < 0.001 LR）。眼部护理、口腔护理或清洗不会导致 ICP 从基线产生任何临床显著变化。在去骨瓣减压术后，没有任何干预措施导致 ICP 发生显著变化。
只有两种护理干预措施，即经气管吸引和 LR，导致中重度颅脑损伤儿童颅内高压，而且在去骨瓣减压术后，任何护理干预都不会导致 ICP 发生任何显著变化。
缺乏对许多重症监护护理干预措施生理效应的了解，在儿科中更为突出。本研究为这一领域的循证基础提供了重要补充，并使重症监护护士能够更有效地计划、实施和评估对脑损伤儿童的护理。
