Summary
Elevation of the head as a common practice to reduce raised intracranial pressure (ICP) has been discussed controversially of late. Some investigators were able to show that besides lowering ICP head elevation may also reduce cerebral perfusion pressure (CPP). For a new evaluation of optimal head position in neurosurgical care it would be of importance to know the influence of body position on cerebral perfusion.
We therefore employed continuous jugular venous oximetry, monitoring cerebral oxygenation, to study the effect of 0°, 15°, 30°, and 45° head elevation on ICP, CPP and jugular venous oxygen saturation (SJVO2) in 25 comatose patients with reduced intracranial compliance.
As expected, head elevation significantly reduced ICP from 19.8 ± 1.3 mmHg at 0° to 10.2 ± 1.2 mmHg at 45°. Already at 30° 92% of the possible effect on ICP was detected. There was no statistically significant change in CPP and SJVO2 associated with varying head position. Individual reactions of CPP to changes in head position, however, were quite unpredictable.
The data suggest that an individual approach to head elevation is to be prefered. A moderate head evelation between 15° and 30° significantly reduces ICP and, in general, does not impair cerebral perfusion. Jugular venous oximetry may be used to optimize ICP, CPP and cerebral oxygenation.
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Schneider, GH., v. Helden, A., Franke, R., Lanksch, W.R., Unterberg, A. (1993). Influence of Body Position on Jugular Venous Oxygen Saturation, Intracranial Pressure and Cerebral Perfusion Pressure. In: Unterberg, A.W., Schneider, GH., Lanksch, W.R. (eds) Monitoring of Cerebral Blood Flow and Metabolism in Intensive Care. Acta Neurochirurgica, vol 59. Springer, Vienna. https://doi.org/10.1007/978-3-7091-9302-0_19
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DOI: https://doi.org/10.1007/978-3-7091-9302-0_19
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