Elevation of the head of the bed to an angle of 20-30° reduces ICP by optimizing cerebral venous return. However, in hypovolemic patients, head elevation may cause a decrease in the CPP. If normovolemia is maintained, elevation to 30° has been shown to decrease ICP without compromising CPP or CBF in head-injured patients.
Care should be taken to avoid obstruction of cerebral venous return by cervical collars or endotracheal tube ties, and to keep the head maintained in the neutral position.
In patients with preserved cerebral autoregulation, elevation of MAP will lead to compensatory vasoconstriction with reduction of ICP.
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