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Effect of a temporary lying position on cerebral hemodynamic and cerebral oxygenation parameters in patients with severe brain trauma

  • Original Article -Brain trauma
  • Published:
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A Correction to this article was published on 16 February 2023

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Abstract

Background

Temporary transition from the half-seated position (HSP) to the lying position (LyP) is often associated with an increase in intracranial pressure (ICP) during management of patients with severe traumatic brain injury (TBI). This study was designed to assess the impact of the temporary LyP on cerebral perfusion and oxygenation in cases of severe TBI.

Method

Patients with a severe blunt TBI with indication of ICP monitoring were prospectively included. Patients underwent standardized management according to the international guidelines to minimize secondary insults. For each patient, a maneuver to a LyP for 30 min was performed daily during the first 7 days of hospitalization. ICP, cerebral perfusion pressure (CPP), mean velocity (Vm), pulsatility index (PI), regional cerebral oxygen saturation (rScO2), jugular venous oxygen saturation (SvjO2)) were compared in the HSP and the LyP.

Results

Twenty-four 24 patients were included. The median Glasgow coma scale score was 6 (interquartile range (IQR), 3–8), the median injury severity score was 32 (IQR, 25–48), and the mean age was 39 ± 16 years. On day 1, ICP (+ 6 mmHg (IQR, 4–7 mmHg)) and CPP (+ 10 mmHg (IQR, 5–14 mmHg) were significantly increased in the LyP compared with the HSP. Vm increased significantly in the LyP on the mainly injured side (+ 6 cm/s (IQR, + 0–11 cm/s); P = 0.01) and on the less injured side (+ 4 cm/s (IQR, + 1–8 cm/s); P < 0.01). rScO2 behaved similarly (+ 2 points (IQR, + 2–4 points) and + 3 points (IQR, + 2–5 points), respectively; P < 0.001). Mixed models highlighted the significant association between the position and CPP, Vm, rScO2, with more favorable conditions in the lying position.

Conclusions

Within the first week of management, the temporary LyP in cases of severe TBI was associated with a moderate increase in CPP, Vm, and rScO2despite a moderate increase in ICP.

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Authors and Affiliations

  1. Trauma Intensive and Critical Care Unit, Lapeyronie University Hospital, 371 Avenue du Doyen G. Giraud, 34295, Montpellier, France

    Geoffrey Dagod, Jean-Paul Roustan, Sophie Bringuier-Branchereau, Jérôme Ridolfo, Orianne Martinez, Xavier Capdevila & Jonathan Charbit

  2. Regional Network of Medical Organization and Management for Severe Trauma in Occitanie, OcciTRAUMA Network, Montpellier, France

    Geoffrey Dagod, Jean-Paul Roustan, Orianne Martinez, Xavier Capdevila & Jonathan Charbit

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  1. Geoffrey Dagod
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Correspondence to Geoffrey Dagod.

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Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the French institutional research committee (ID RCB 2014-A00708-39), the French data protection authority (CNIL) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare that they have no conflict of interest.

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ClinicalTrials.gov Identifier: NCT02832908

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Dagod, G., Roustan, JP., Bringuier-Branchereau, S. et al. Effect of a temporary lying position on cerebral hemodynamic and cerebral oxygenation parameters in patients with severe brain trauma. Acta Neurochir 163, 2595–2602 (2021). https://doi.org/10.1007/s00701-021-04851-x

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