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

Roth, Christian; Ferbert, A.; Deinsberger, Wolfgang; Kleffmann, Jens; Kästner, Stefanie; Godau, Jana; Schuler, M; Tryba, M.; Gehling, M.

doi:10.1007/s12028-014-0004-x

Cited by 75 publications

(59 citation statements)

References 17 publications

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“…In a more recent study conducted by Roth et al (47) a moderate but significant elevation of ICP during prone positioning was demonstrated. However, the oxygenation during and after prone positioning shows a significant improvement and the achieved increase of oxygenation and PbO 2 by far exceeds and the changes in ICP (47). In conclusion, there is no clear evidence to aid intensivists when deciding whether or not proning a patient when there is co-existence of ARDS and TBI; however, it doesn't seem unreasonable to attempt prone ventilation when hypoxemia is refractory to conventional ventilation.…”

Section: Prone Positioningmentioning

confidence: 84%

“…In their cohort of patients the authors also observed that the ARDS cases of extrapulmonary origin seem to respond better to the prone position, compared with pulmonary ARDS (46). In a more recent study conducted by Roth et al (47) a moderate but significant elevation of ICP during prone positioning was demonstrated. However, the oxygenation during and after prone positioning shows a significant improvement and the achieved increase of oxygenation and PbO 2 by far exceeds and the changes in ICP (47).…”

Section: Prone Positioningmentioning

confidence: 85%

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Acute respiratory distress syndrome in traumatic brain injury: how do we manage it?

Torre¹,

Badenes²,

Corradi³

et al. 2017

J. Thorac. Dis.

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Traumatic brain injury (TBI) is an important cause of morbidity and mortality worldwide. TBI patients frequently suffer from lung complications and acute respiratory distress syndrome (ARDS), which is associated with poor clinical outcomes. Moreover, the association between TBI and ARDS in trauma patients is well recognized. Mechanical ventilation of patients with a concomitance of acute brain injury and lung injury can present significant challenges. Frequently, guidelines recommending management strategies for patients with traumatic brain injuries come into conflict with what is now considered best ventilator practice. In this review, we will explore the strategies of the best practice in the ventilatory management of patients with ARDS and TBI, concentrating on those areas in which a conflict exists. We will discuss the use of ventilator strategies such as protective ventilation, high positive end expiratory pressure (PEEP), prone position, recruitment maneuvers (RMs), as well as techniques which at present are used for 'rescue' in ARDS (including extracorporeal membrane oxygenation) in patients with TBI. Furthermore, general principles of fluid, haemodynamic and hemoglobin management will be discussed. Currently, there are inadequate data addressing the safety or efficacy of ventilator strategies used in ARDS in adult patients with TBI. At present, choice of ventilator rescue strategies is best decided on a case-by-case basis in conjunction with local expertise.

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Section: Prone Positioningmentioning

confidence: 84%

Section: Prone Positioningmentioning

confidence: 85%

Acute respiratory distress syndrome in traumatic brain injury: how do we manage it?

Torre¹,

Badenes²,

Corradi³

et al. 2017

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

“…Prone positioning during craniotomy could increase intraabdominal pressure and compromise venous return, which could lead to cerebral venous hypertension and increased ICP [13]. Accordingly, we positioned the patient in the supine lateral position with a large cushion under the ipsilateral shoulder, which facilitated head rotation; we then turned the neck, being careful not to press on the jugular vein.…”

Section: Discussionmentioning

confidence: 99%

Failed First Craniotomy and Tumor Removal of Parasagittal Meningioma with Severe Peritumoral Brain Edema

Shim

Lee

2016

Brain Tumor Res Treat

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Parasagittal meningioma often presents as peritumoral brain edema (PTBE). The risk of edema increases when the tumor occludes the superior sagittal sinus (SSS). Although PTBE may be expected based on the patient’s symptoms or radiologic findings, extensive brain swelling and extracranial herniation during elective surgery are rare. Herniation during surgery could lead to irreversible neurological damage and even brain rupture. We report a case of a failed routine craniotomy for a parasagittal meningioma with complete occlusion of the posterior third of the SSS in a 30-year-old male patient. The patient developed extensive brain swelling and extracranial herniation during surgery.

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“…[91][92][93] The limited numbers of studies that have examined the efficacy of prone position in subjects with brain injury have found that prone position causes a slight increase in ICP; however, this is eclipsed by the clear benefit of improved oxygenation. [94][95][96][97][98] One study evaluated P btO 2 in subjects with ARDS and concurrent subarachnoid hemorrhage and showed that prone position was well tolerated and resulted in significant increases in P btO 2 . 94 Although more studies examining the intersection of brain and lung need to be done, the available data suggest that if a ventilatory strategy results in an improved P aO 2 /F IO 2 ratio, the benefits of improved P aO 2 will be reflected in brain tissue oxygen monitoring and improved patient outcome.…”

Section: Lung-protective Strategies and Brain Tissue Oxygenmentioning

confidence: 99%

Brain Tissue Oxygen Monitoring and the Intersection of Brain and Lung: A Comprehensive Review

2016

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SummaryTraumatic brain injury is a problem that affects millions of Americans yearly and for which there is no definitive treatment that improves outcome. Continuous brain tissue oxygen (P btO 2 ) monitoring is a complement to traditional brain monitoring techniques, such as intracranial pressure and cerebral perfusion pressure. P btO 2 monitoring has not yet become a clinical standard of care, due to several unresolved questions. In this review, we discuss the rationale and technology of P btO 2 monitoring. We review the literature, both historic and current, and show that continuous P btO 2 monitoring is feasible and useful in patient management. P btO 2 numbers reflect cerebral blood flow and oxygen diffusion. Thus, continuous monitoring of P btO 2 yields important information about both the brain and the lung. The preclinical and clinical studies demonstrating these findings are discussed. In this review, we demonstrate that patient management in a P btO 2 -directed fashion is not the sole answer to the problem of treating traumatic brain injury but is an important adjunct to the armamentarium of multimodal neuromonitoring.

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

Cited by 75 publications

References 17 publications

Acute respiratory distress syndrome in traumatic brain injury: how do we manage it?

Acute respiratory distress syndrome in traumatic brain injury: how do we manage it?

Failed First Craniotomy and Tumor Removal of Parasagittal Meningioma with Severe Peritumoral Brain Edema

Brain Tissue Oxygen Monitoring and the Intersection of Brain and Lung: A Comprehensive Review

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