The purpose of this study was to determine if administering two painful stimuli used to assess motor responses in patients with brain injury, nail bed compression (NBC) and supraorbital pressure (SOP), had an effect on intracranial pressure (ICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), heart rate (HR), and motor responses, in unconscious patients. Thirteen unconscious adult male and female subjects with brain injury were enrolled in the study. All subjects had normal ICP and CPP, and were hemodynamically stable. After collection of baseline values of the dependent variables, NBC and SOP were delivered on both sides of the body while ICP, MAP, CPP and HR were recorded from the bedside monitor. Subjects were recorded on video tape for motor responses to NBC and SOP and later given a motor score on the Glasgow Coma Scale. Pressures used to administer NBC and SOP were measured in psi by devices constructed for purposes of this study. Data were analyzed using MANOVA statistical procedures to detect differences within subjects on all physiological values from baseline. Findings from this study were that NBC and SOP administered on both sides of the body resulted in statistically significant increases in ICP, MAP, CPP, and HR from baseline for a brief, yet unsustained time period (p = $<$0.05). The ICP had returned to baseline in 30 seconds, the MAP and CPP within four minutes, and HR by the second minute after administration of NBC and SOP. ANOVA statistical procedure was used to detect differences in motor scores when NBC and SOP were given. There were no statistical differences between motor scores on the GCS with NBC or SOP. The mean pressures that were measured on NBC and SOP were 77.11 $\pm$ 30.98 and 86.1 $\pm$ 8.54 psi, respectively. These data suggest that NBC and SOP do have an effect on physiological indices of cerebral perfusion by an increasing ICP, MAP, CPP, and HR for a brief period of time but return to baseline quickly. Therefore, administering painful stimuli to evaluate motor responses in unconscious patients who have normal ICP and CPP is probably safe. Also, the data suggest that NBC and SOP produce similar motor responses and could both be used to assess unconscious patients.
| Identifer | oai:union.ndltd.org:UMASS/oai:scholarworks.umass.edu:dissertations-3026 |
| Date | 01 January 1998 |
| Creators | Aragon, Elizabeth Dale |
| Publisher | ScholarWorks@UMass Amherst |
| Source Sets | University of Massachusetts, Amherst |
| Language | English |
| Detected Language | English |
| Type | text |
| Source | Doctoral Dissertations Available from Proquest |
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