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학습 자료 둘러보기 →The first intervention for a client with signs of brainstem herniation (decerebrate posturing, sluggish dilated pupils) and an ICP of 28 mmHg is to elevate the head of the bed to 30 degrees and ensure neutral neck alignment. This promotes cerebral venous outflow via the jugular veins, immediately reducing intracranial blood volume and ICP.
Maintaining a CPP above 60 mmHg is critical. Head-of-bed elevation at 30 degrees optimizes cerebral hemodynamics and oxygenation without impairing autoregulation, balancing the need to lower ICP while preserving adequate perfusion.
Avoid hyperventilation as a first-line intervention. Targeting a PaCO2 of 25-30 mmHg causes cerebral vasoconstriction and can lead to ischemia. Also, avoid hip flexion or neck rotation, which can impede venous return and increase ICP.
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