• Matthew J Meyer, Joseph Megyesi, Jay Meythaler, Manuel Murie-Fernandez, Jo-Anne Aubut, Norine Foley, Katherine Salter, Mark Bayley, Shawn Marshall, and Robert Teasell.
• Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada.
• Brain Inj. 2010 Jan 1;24(5):694-705.

Primary ObjectiveTo review the literature on non-pharmacological interventions used in acute settings to manage elevated intracranial pressure (ICP) and minimize cerebral damage in patients with acquired brain injury (ABI).Main OutcomesA literature search of multiple databases (CINAHL, EMBASE, MEDLINE and PSYCHINFO) and hand-searched articles covering the years 1980-2008 was performed. Peer reviewed articles were assessed for methodological quality using the PEDro scoring system for randomized controlled trials (RCTs) and the Downs and Black tool for RCTs and non-randomized trials. Levels of evidence were assigned and recommendations made.ResultsFive non-invasive interventions for acute ABI management were assessed: adjusting head posture, body rotation (continuous rotational therapy and prone positioning), hyperventilation, hypothermia and hyperbaric oxygen. Two invasive interventions were also reviewed: cerebrospinal fluid (CSF) drainage and decompressive craniectomy (DC).ConclusionsThere is a paucity of information regarding non-pharmacological acute management of patients with ABI. Strong levels of evidence were found for only four of the seven interventions (decompressive craniectomy, cerebrospinal fluid drainage, hypothermia and hyperbaric oxygen) and only for specific components of their use. Further research into all interventions is warranted.

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