Head position affects intracranial pressure in newborn infants

Emery, Janet R.; Peabody, Joyce L.

doi:10.1016/s0022-3476(83)80728-8

Cited by 63 publications

(23 citation statements)

References 16 publications

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“…Most studies in neurosurgical patient collectives agree that moderate head elevation decreases ICP in patients with head trauma. [1][2][3]5,6,9,11 However, in head trauma patients, head elevation also decreases CPP because of a marked decrease in MAP. 3,4 Some authors have examined CBF in relation to body position.…”

Section: Discussionmentioning

confidence: 99%

“…Great care was taken to keep the head in a neutral midline position because rotatory and flexion-extension movements of the neck could substantially alter the ICP. 9 For each step, the arterial blood pressure transducer was recalibrated and positioned at the level of the foramen of Monro. An example of a single monitoring session is depicted in Figure 1.…”

Section: Methodsmentioning

confidence: 99%

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Effects of Body Position on Intracranial Pressure and Cerebral Perfusion in Patients With Large Hemispheric Stroke

Schwarz

Georgiadis

Aschoff

et al. 2002

Stroke

188

139

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Background and Purpose-The purpose of this study was to prospectively evaluate the effects of body position in patients with large supratentorial stroke. Methods-We performed 43 monitoring sessions in 18 patients with acute complete or subtotal middle cerebral artery (MCA) territory stroke. Intracranial pressure (ICP) was monitored with a parenchymal probe. Mean arterial blood pressure, ICP, and MCA peak mean flow velocity (V m MCA) were continuously recorded. Patients with acute ICP crises were excluded. After baseline values at a 0°supine position were attained, the backrest was elevated in 2 steps of 5 minutes each to 15°and 30°and then returned to 0°. Results-Baseline mean arterial pressure was 90.0Ϯ1.6 mm Hg and fell to 82.7Ϯ1.7 mm Hg at 15°and 76.1Ϯ1.6 mm Hg at 30°backrest elevation (PϽ0.0001). ICP decreased from 13.0Ϯ0.9 to 12.0Ϯ0.9 mm Hg at 15°a nd 11.4Ϯ0.9 mm Hg at 30°backrest elevation (PϽ0.0001). As a result, cerebral perfusion pressure decreased from a baseline value of 77.0Ϯ1.8 to 70.0Ϯ1.8 mm Hg at 15°and 64.7Ϯ1.7 mm Hg at 30°backrest elevation (PϽ0.0001). V m MCA was already higher on the affected side during baseline measurements. V m MCA decreased from 72.8Ϯ11.3 cm/s at 0°to 67.2Ϯ9.7 cm/s at 15°and 61.2Ϯ8.9 cm/s at 30°on the affected and from 49.9Ϯ3.7 cm/s at 0°to 47.7Ϯ3.6 cm/s at 15°and 46.2Ϯ2.2 cm/s at 30°on the contralateral side (PϽ0.0001). Conclusions-In patients with large hemispheric stroke without an acute ICP crisis, cerebral perfusion pressure was maximal in the horizontal position although ICP was usually at its highest point. If adequate cerebral perfusion pressure is considered more desirable than the absolute level of ICP, the horizontal position is optimal for these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Effects of Body Position on Intracranial Pressure and Cerebral Perfusion in Patients With Large Hemispheric Stroke

Schwarz

Georgiadis

Aschoff

et al. 2002

Stroke

188

139

View full text Add to dashboard Cite

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“…10,11 Head elevation augments venous drainage of the head and reduces ICP in the ICU setting. [4][5][6][7][8][9] Enhanced venous drainage induced by head elevation may off-set the effect of impaired venous drainage caused by head rotation resulting in a reduced risk for intracranial hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…Head elevation lowers ICP 2,3 and reduces intracranial hypertension secondary to trauma and intracranial hemorrhage in the ICU setting. [4][5][6][7][8][9] Head rotation increases ICP by impeding venous drainage of the head in adults 10,11 and infants. 1 3 The increase in ICP associated with head rotation in infants was reduced by concomitant head elevation.…”

mentioning

confidence: 99%

Head elevation reduces head-rotation associated increased ICP in patients with intracranial tumours

Hung

Hare

Brien

2000

Can J Anesth/J Can Anesth

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Purpose: To quantify the effects of graded head rotation and elevation on intracranial pressure (ICP) in neurosurgical patients, before and after induction of general anesthesia.Methods: Patients with supratentorial tumours (n=12), scheduled for craniotomy with planned ICP monitoring, underwent baseline ICP measurements awake and supine (0° rotation and elevation). Incremental degrees of head rotation (15°) and of head elevation (10°) were performed independently and in combination. Paired measurements of ICP at all levels of head rotation and elevation were also performed before and after induction of general anesthesia (n=6).Results: The baseline ICP was 12.3 ± 6.4 mmHg (n=12). Changes of ICP were proportional to the degree of head rotation or elevation. Head rotation of 60° maximally increased ICP to 24.8 ± 14.3 mmHg (P < 0.05). Head elevation above 20° reduced ICP, with a maximal reduction to -0.2 ± 5.5 mmHg at 40° elevation (P < 0.01). Head elevation to 30° reduced the intracranial hypertension associated with head rotation. No differences were observed between ICP measurements made before or after induction of general anesthesia (n=6). Three patients experienced headache with extreme head rotation (<60°) and intracranial hypertension (ICP > 20 mmHg).Conclusion: Head rotation of 60° caused an increase in ICP. Concomitant head elevation to 30° reduced the intracranial hypertension associated with head rotation. Headache with head rotation may provide a useful clinical warning of elevated ICP.Objectif : Quantifier les effets de la rotation et de l'élévation graduées de la tête sur la tension intracrânienne (TIC) chez des patients de neurochirurgie, avant et après l'induction de l'anesthésie générale. Résultats : La TIC de base était de 12,3 ± 6,4 mmHg (n=12). Les changements de TIC ont été proportionnels au degré de rotation et d'élévation de la tête. La rotation de 60 o a conduit à la TIC maximale de 24,8 ± 14,3 mmHg (P < 0,05). L'élévation au-dessus de 20 o a réduit la TIC, la réduction maximale étant de -0,2 ± 5,5 mmHg à 40 o d'élévation (P < 0,01). L'élévation de la tête à 30 o a réduit l'hypertension intracrânienne associée à la rotation de la tête. Aucune différence de TIC n'a été notée entre les mesures prises avant ou après l'induction de l'anesthésie générale (n=6). Trois patients ont éprouvé des céphalées au moment de la rotation extrême de la tête (<60 o ) et une hypertension intracrânienne (TIC) > 20 mmHg.Conclusion : La rotation de la tête de 60 o a causé une augmentation de la TIC. L'élévation concomitante de la tête à 30 o a réduit la TIC associée à la rotation de la tête. Les céphalées associées à la rotation de la tête peuvent servir d'indice clinique d'une TIC élevée.

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“…It is noteworthy that the head of the bed was elevated 30 degrees in all of the four positions named above, according to references which consider this beneficial to reduce cerebral venous pressure by increasing hydrostatic brain drainage (32,33).…”

Section: Methodsmentioning

confidence: 99%

Cerebral Tissue Oxygenation in Postural Changes in Mechanically Ventilated Preterm Newborns Less than 72 Hours after Birth

et al. 2017

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Background: Positioning is a part of routine neonatal care in most neonatal intensive care units. Optimal positioning has been controversially advocated as a practice for providing better neuro-developmental outcomes in prematures. Objectives: To evaluate by near-infrared spectroscopy (NIRS) the effect of changing posture on regional saturation of oxygen (rSO2) in the brain in mechanically ventilated preterm newborns during first 3 days after delivery. Methods: Twenty stable ventilated preterm newborns were studied by NIRS in four different positions sequentially including supine, right-side-lying, prone, and left-side-lying, as well as in 3 intermediate periods between the four main positions.

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Head position affects intracranial pressure in newborn infants

Cited by 63 publications

References 16 publications

Effects of Body Position on Intracranial Pressure and Cerebral Perfusion in Patients With Large Hemispheric Stroke

Effects of Body Position on Intracranial Pressure and Cerebral Perfusion in Patients With Large Hemispheric Stroke

Head elevation reduces head-rotation associated increased ICP in patients with intracranial tumours

Cerebral Tissue Oxygenation in Postural Changes in Mechanically Ventilated Preterm Newborns Less than 72 Hours after Birth

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