Neurocritical Care

, Volume 21, Issue 2, pp 186–191

Does Prone Positioning Increase Intracranial Pressure? A Retrospective Analysis of Patients with Acute Brain Injury and Acute Respiratory Failure

  • Christian Roth
  • Andreas Ferbert
  • Wolfgang Deinsberger
  • Jens Kleffmann
  • Stefanie Kästner
  • Jana Godau
  • Marc Schüler
  • Michael Tryba
  • Markus Gehling
Original Article

DOI: 10.1007/s12028-014-0004-x

Cite this article as:
Roth, C., Ferbert, A., Deinsberger, W. et al. Neurocrit Care (2014) 21: 186. doi:10.1007/s12028-014-0004-x

Abstract

Purpose

The objective of our trial was to obtain more comprehensive data on the risks and benefits of kinetic therapy in intensive care patients with intracerebral pathology.

Methods

Standardized data of prone positioning in our NeuroIntensive Care Unit were collected from 2007 onward. A post hoc analysis of all available data was undertaken, with special consideration given to values of intracranial pressure (ICP), cerebral perfusion pressure (CPP) and oxygenation in correlation to prone (PP), or supine positioning (SP) of patients. Cases were considered eligible if kinetic therapy and ICP were documented. Prone positioning was performed in a 135° position for 8 h per treatment unit.

Results

A total of 115 patients treated with prone positioning from 2007 to 2013 were identified in our medical records. Of these, 29 patients received ICP monitoring. Overall, 119 treatment units of prone positioning with a mean duration of 2.5 days per patient were performed. The mean baseline ICP in SP was 9.5 ± 5.9 mmHg and was increased significantly during PP (p < 0.0001). There was no significant difference between CPP in SP (82 ± 14.5 mmHg) compared to PP (p > 0.05). ICP values >20 mmHg occurred more often during PP than SP (p < 0.0001) and were associated with significantly more episodes of decreased CPP <70 mmHg (p < 0.0022). The mean paO2/FiO2 ratio (P/F ratio) was increased significantly in prone positioning of patients (p < 0.0001).

Conclusions

The analyzed data allow a more precise understanding of changes in ICP and oxygenation during prone positioning in patients with acute brain injury and almost normal baseline ICP. Our study shows a moderate, yet significant elevation of ICP during prone positioning. However, the achieved increase of oxygenation by far exceeded the changes in ICP. It is evident that continuous monitoring of cerebral pressure is required in this patient group.

Keywords

Prone position ICP ARDS CPP Respiratory failure Intracranial pressure Monitoring 

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Christian Roth
    • 1
  • Andreas Ferbert
    • 1
  • Wolfgang Deinsberger
    • 2
  • Jens Kleffmann
    • 2
  • Stefanie Kästner
    • 2
  • Jana Godau
    • 1
  • Marc Schüler
    • 3
  • Michael Tryba
    • 3
  • Markus Gehling
    • 3
    • 4
  1. 1.Department of NeurologyKlinikum KasselKasselGermany
  2. 2.Department of NeurosurgeryKlinikum KasselKasselGermany
  3. 3.Department of Anaesthesiology, Intensive Care Medicine and Pain TherapyKlinikum KasselKasselGermany
  4. 4.Department of Anaesthesiology and Intensive Care MedicinePhilipps University of MarburgMarburgGermany