The Effects of Head Elevation on Intracranial Pressure, Cerebral Perfusion Pressure, and Cerebral Oxygenation Among Patients with Acute Brain Injury: A Systematic Review and Meta-Analysis.

Autor: Ramos MB; Department Neurosurgery, Hospital Do Servidor Público Estadual de São Paulo, São Paulo, Brazil., Britz JPE; Department of Neurosurgery, Hospital Cristo Redentor, Grupo Hospitalar Conceição, Porto Alegre, Brazil., Telles JPM; Department of Neurology, University of São Paulo, São Paulo, Brazil., Nager GB; School of Medicine, Universidade Federal Do Estado Do Rio de Janeiro, Rio de Janeiro, Brazil., Cenci GI; School of Medicine, Faculdade Meridional, Passo Fundo, Brazil., Rynkowski CB; Intensive Care Unit, Hospital Cristo Redentor, Porto Alegre, Brazil., Teixeira MJ; Division of Neurosurgery, School of Medicine, University of São Paulo, São Paulo, Brazil., Figueiredo EG; Division of Neurosurgery, School of Medicine, University of São Paulo, São Paulo, Brazil. ebgadelha@yahoo.com.
Jazyk: angličtina
Zdroj: Neurocritical care [Neurocrit Care] 2024 Dec; Vol. 41 (3), pp. 950-962. Date of Electronic Publication: 2024 Jun 17.
DOI: 10.1007/s12028-024-02020-3
Abstrakt: Background: Head elevation is recommended as a tier zero measure to decrease high intracranial pressure (ICP) in neurocritical patients. However, its quantitative effects on cerebral perfusion pressure (CPP), jugular bulb oxygen saturation (SjvO 2 ), brain tissue partial pressure of oxygen (PbtO 2 ), and arteriovenous difference of oxygen (AVDO 2 ) are uncertain. Our objective was to evaluate the effects of head elevation on ICP, CPP, SjvO 2 , PbtO 2 , and AVDO 2 among patients with acute brain injury.
Methods: We conducted a systematic review and meta-analysis on PubMed, Scopus, and Cochrane Library of studies comparing the effects of different degrees of head elevation on ICP, CPP, SjvO 2 , PbtO 2 , and AVDO 2 .
Results: A total of 25 articles were included in the systematic review. Of these, 16 provided quantitative data regarding outcomes of interest and underwent meta-analyses. The mean ICP of patients with acute brain injury was lower in group with 30° of head elevation than in the supine position group (mean difference [MD] - 5.58 mm Hg; 95% confidence interval [CI] - 6.74 to - 4.41 mm Hg; p < 0.00001). The only comparison in which a greater degree of head elevation did not significantly reduce the ICP was 45° vs. 30°. The mean CPP remained similar between 30° of head elevation and supine position (MD - 2.48 mm Hg; 95% CI - 5.69 to 0.73 mm Hg; p = 0.13). Similar findings were observed in all other comparisons. The mean SjvO 2 was similar between the 30° of head elevation and supine position groups (MD 0.32%; 95% CI - 1.67% to 2.32%; p = 0.75), as was the mean PbtO 2 (MD - 1.50 mm Hg; 95% CI - 4.62 to 1.62 mm Hg; p = 0.36), and the mean AVDO 2 (MD 0.06 µmol/L; 95% CI - 0.20 to 0.32 µmol/L; p = 0.65).The mean ICP of patients with traumatic brain injury was also lower with 30° of head elevation when compared to the supine position. There was no difference in the mean values of mean arterial pressure, CPP, SjvO 2 , and PbtO 2 between these groups.
Conclusions: Increasing degrees of head elevation were associated, in general, with a lower ICP, whereas CPP and brain oxygenation parameters remained unchanged. The severe traumatic brain injury subanalysis found similar results.
Competing Interests: Declarations. Conflicts of interest: The authors declare that they have no conflicts of interest. Ethical approval/informed consent: This article complies with ethical standards, and institutional review board approval was not required.
(© 2024. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.)
Databáze: MEDLINE
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