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The Impact of Head-of-Bed Positioning and Transducer Location on Cerebral Perfusion Pressure Measurement

McNett, Molly; Livesay, Sarah; Yeager, Susan; Moran, Cristina; Supan, Erin; Ortega, Stefany; Olson, DaiWai M.

Journal of Neuroscience Nursing: December 2018 - Volume 50 - Issue 6 - p 322–326
doi: 10.1097/JNN.0000000000000398

ABSTRACT Introduction: Head-of-bed (HOB) elevation is the standard of care for patients with intracranial pressure monitoring at risk for intracranial hypertension. Measurement of cerebral perfusion pressure (CPP) based on HOB elevation and arterial transducer position has not been adequately studied. Methods: This is a planned secondary analysis of prospectively collected data in which paired, serial arterial blood pressure (ABP), intracranial pressure, and CPP measures were obtained once per day for 3 days, with measures leveled at the tragus (Tg) and the phlebostatic axis (PA). The HOB position was recorded for all paired readings. Results: From 136 subjects, ABP and CPP values were lower when the transducer was leveled at the Tg, compared with the PA (P < .001); these differences persisted regardless of HOB position. Conclusion: The difference in CPP when ABP is referenced at the Tg versus PA is not consistently attributed to HOB elevation.

Sarah Livesay, DNP ACNP FNCS, is Associate Professor, Rush University, Chicago, IL.

Susan Yeager, MS ACNP FNCS, is Nurse Practitioner Lead, Wexner Medical Center, The Ohio State University, Columbus, OH.

Cristina Moran, MSN RN CCRN, is Clinical Nurse, The MetroHealth System, Cleveland, OH.

Erin Supan, MSN RN, is Clinical Nurse Specialist, Neurosciences, University Hospitals Cleveland Medical Center, Cleveland, OH.

Stefany Ortega, MSc RN, is Assistant Professor, Universidad del Norte, Barranquilla, Colombia.

DaiWai M. Olson, PhD RN CCRN FNCS, is Professor of Neurosurgery and Neurotherapeutics, University of Texas Southwestern, Dallas, TX.

Questions or comments about this article may be directed to Molly McNett, PhD RN CNRN FNCS, at She is Director, Nursing Research & Evidence Based Practice, The MetroHealth System, Cleveland, OH.

M.M. has received research funding from the Agnes Marshall Walker Foundation for this study. S.L. is an independent consultant and paid consultant for Stryker Medical. S.Y., C.M., S.O., and E.S. have no disclosures. D.M.O. is the Editor-in-Chief of the Journal of Neuroscience Nursing.

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© 2018 American Association of Neuroscience Nurses