Limitations of prone positioning in patients with aneurysmal subarachnoid hemorrhage and concomitant respiratory failure

Prone positioning (PP) is an established treatment modality for respiratory failure. After aneurysmal subarachnoid hemorrhage (aSAH), PP is rarely performed considering the risk of intracranial hypertension. The aim of this study was to analyze the effects of PP on intracranial pressure (ICP), cereb...

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Bibliographic Details
Published in:Clinical neurology and neurosurgery 2023-09, Vol.232, p.107878, Article 107878
Main Authors: Leppert, Jan, Ditz, Claudia, Souayah, Noura, Behrens, Carianne, Tronnier, Volker M., Küchler, Jan
Format: Article
Language:English
Subjects:
Anesthesia
Aneurysm
Aneurysmal subarachnoid hemorrhage
Aneurysms
Brain tissue oxygenation
Data collection
Edema
Hemorrhage
Hypertension
Intracranial pressure
Ischemia
Medical imaging
Mortality
Neurology
Oxygenation
Patient positioning
Patients
Prone position
Respiratory failure
Subarachnoid hemorrhage
Variance analysis
Ventilators
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Summary:Prone positioning (PP) is an established treatment modality for respiratory failure. After aneurysmal subarachnoid hemorrhage (aSAH), PP is rarely performed considering the risk of intracranial hypertension. The aim of this study was to analyze the effects of PP on intracranial pressure (ICP), cerebral perfusion pressure (CPP) and cerebral oxygenation following aSAH. Patients and methods: Demographic and clinical data of aSAH patients admitted over a 6-year period and treated with PP due to respiratory insufficiency were retrospectively analyzed. ICP, CPP, brain tissue oxygenation (pBrO2), respiratory parameters and ventilator settings were analyzed before and during PP. Thirty patients receiving invasive multimodal neuromonitoring were included. Overall, 97 PP sessions were performed. Mean arterial oxygenation and pBrO2 increased significantly during PP. We found a significant increase in median ICP compared to the baseline level in supine position. No significant changes in CPP were observed. Five PP sessions had to be terminated early due to medically refractory ICP-crisis. The affected patients were younger (p = 0.02) with significantly higher baseline ICP values (p = 0.009). Baseline ICP correlates significantly (p 
ISSN:0303-8467
1872-6968
1872-6968
DOI:10.1016/j.clineuro.2023.107878