Which positioning reduces intracranial pressure in a patient with head injury?

• A. Lie completely flat with head midline
• B. Prone position
• C. Turn head to one side
• D. Elevate HOB to 30 degrees

Answer: (D)

Positioning affects intracranial pressure by changing venous outflow from the brain. Elevating the head of the bed to about 30 degrees helps promote drainage of venous blood from the brain, lowering ICP while preserving cerebral perfusion if blood pressure is adequate. Keeping the head in a midline position prevents obstruction of the jugular veins. Lying completely flat raises venous pressure and ICP; turning the head to one side can kink a jugular vein and impede drainage; a prone position can also increase ICP and complicate airway management. So elevating the head to 30 degrees provides better venous drainage with maintained perfusion, making it the best approach to reduce ICP in head injury.