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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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| Published in: | Clinical neurology and neurosurgery 2023-09, Vol.232, p.107878, Article 107878 |
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| container_title | Clinical neurology and neurosurgery |
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| creator | Leppert, Jan Ditz, Claudia Souayah, Noura Behrens, Carianne Tronnier, Volker M. Küchler, Jan |
| description | 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 |
| doi_str_mv | 10.1016/j.clineuro.2023.107878 |
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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 < 0.001) with ICP 1 h (R: 0.57) and 4 h (R: 0.55) after onset of PP.
PP in aSAH patients with respiratory insufficiency is an effective therapeutic option improving arterial and global cerebral oxygenation without compromising CPP. The significant increase in ICP was moderate in most sessions. However, as some patients experience intolerable ICP crises during PP, continuous ICP-Monitoring is considered mandatory. Patients with elevated baseline ICP and reduced intracranial compliance should not be considered for PP.
•Prone positioning improves cerebral oxygenation in SAH patients.•Prone positioning significantly increases ICP in SAH patients.•Medically refractory ICP crisis occur in about 5% of proning sessions.•‘Younger age’ might pose a risk factors for medically refractory ICP crisis.</description><identifier>ISSN: 0303-8467</identifier><identifier>ISSN: 1872-6968</identifier><identifier>EISSN: 1872-6968</identifier><identifier>DOI: 10.1016/j.clineuro.2023.107878</identifier><identifier>PMID: 37423091</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>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 ; Stroke ; Subarachnoid hemorrhage ; Variance analysis ; Ventilators</subject><ispartof>Clinical neurology and neurosurgery, 2023-09, Vol.232, p.107878, Article 107878</ispartof><rights>2023 Elsevier B.V.</rights><rights>Copyright © 2023 Elsevier B.V. All rights reserved.</rights><rights>2023. Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c343t-8b15db68fd5087119ff84e62436416c9561500b2a3c992b29810407b835997333</cites><orcidid>0000-0002-2925-8537</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37423091$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Leppert, Jan</creatorcontrib><creatorcontrib>Ditz, Claudia</creatorcontrib><creatorcontrib>Souayah, Noura</creatorcontrib><creatorcontrib>Behrens, Carianne</creatorcontrib><creatorcontrib>Tronnier, Volker M.</creatorcontrib><creatorcontrib>Küchler, Jan</creatorcontrib><title>Limitations of prone positioning in patients with aneurysmal subarachnoid hemorrhage and concomitant respiratory failure</title><title>Clinical neurology and neurosurgery</title><addtitle>Clin Neurol Neurosurg</addtitle><description>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 < 0.001) with ICP 1 h (R: 0.57) and 4 h (R: 0.55) after onset of PP.
PP in aSAH patients with respiratory insufficiency is an effective therapeutic option improving arterial and global cerebral oxygenation without compromising CPP. The significant increase in ICP was moderate in most sessions. However, as some patients experience intolerable ICP crises during PP, continuous ICP-Monitoring is considered mandatory. Patients with elevated baseline ICP and reduced intracranial compliance should not be considered for PP.
•Prone positioning improves cerebral oxygenation in SAH patients.•Prone positioning significantly increases ICP in SAH patients.•Medically refractory ICP crisis occur in about 5% of proning sessions.•‘Younger age’ might pose a risk factors for medically refractory ICP crisis.</description><subject>Anesthesia</subject><subject>Aneurysm</subject><subject>Aneurysmal subarachnoid hemorrhage</subject><subject>Aneurysms</subject><subject>Brain tissue oxygenation</subject><subject>Data collection</subject><subject>Edema</subject><subject>Hemorrhage</subject><subject>Hypertension</subject><subject>Intracranial pressure</subject><subject>Ischemia</subject><subject>Medical imaging</subject><subject>Mortality</subject><subject>Neurology</subject><subject>Oxygenation</subject><subject>Patient positioning</subject><subject>Patients</subject><subject>Prone position</subject><subject>Respiratory failure</subject><subject>Stroke</subject><subject>Subarachnoid hemorrhage</subject><subject>Variance analysis</subject><subject>Ventilators</subject><issn>0303-8467</issn><issn>1872-6968</issn><issn>1872-6968</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNqFkctu1DAUhi0EokPhFSpLbNhk8C2-7EBVgUojsYG15ThOx6PEDrbTdt6-jqbTRTesjnTOd_5z-QG4wmiLEeZfD1s7-uCWFLcEEVqTQgr5BmywFKThisu3YIMooo1kXFyADzkfEEKUcvkeXFDBCEUKb8Djzk--mOJjyDAOcE4xODjH7NeUD3fQBzjXugslwwdf9tCsY495MiPMS2eSsfsQfQ_3boop7c2dq0gPbQw2rtqhwOTy7JMpMR3hYPy4JPcRvBvMmN2n53gJ_v64-XP9q9n9_nl7_X3XWMpoaWSH277jcuhbJAXGahgkc5wwyhnmVrUctwh1xFCrFOmIkhgxJDpJW6UEpfQSfDnp1sv-LS4XPfls3TjWM-KSNZEtYxQLoSr6-RV6iEsKdbtKcUpkZXGl-ImyKeac3KDn5CeTjhojvXqjD_rsjV690SdvauPVs_zSTa5_aTubUYFvJ8DVf9x7l3S29e_W9T45W3Qf_f9mPAH1e6SD</recordid><startdate>20230901</startdate><enddate>20230901</enddate><creator>Leppert, Jan</creator><creator>Ditz, Claudia</creator><creator>Souayah, Noura</creator><creator>Behrens, Carianne</creator><creator>Tronnier, Volker M.</creator><creator>Küchler, Jan</creator><general>Elsevier B.V</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2925-8537</orcidid></search><sort><creationdate>20230901</creationdate><title>Limitations of prone positioning in patients with aneurysmal subarachnoid hemorrhage and concomitant respiratory failure</title><author>Leppert, Jan ; Ditz, Claudia ; Souayah, Noura ; Behrens, Carianne ; Tronnier, Volker M. ; Küchler, Jan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c343t-8b15db68fd5087119ff84e62436416c9561500b2a3c992b29810407b835997333</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Anesthesia</topic><topic>Aneurysm</topic><topic>Aneurysmal subarachnoid hemorrhage</topic><topic>Aneurysms</topic><topic>Brain tissue oxygenation</topic><topic>Data collection</topic><topic>Edema</topic><topic>Hemorrhage</topic><topic>Hypertension</topic><topic>Intracranial pressure</topic><topic>Ischemia</topic><topic>Medical imaging</topic><topic>Mortality</topic><topic>Neurology</topic><topic>Oxygenation</topic><topic>Patient positioning</topic><topic>Patients</topic><topic>Prone position</topic><topic>Respiratory failure</topic><topic>Stroke</topic><topic>Subarachnoid hemorrhage</topic><topic>Variance analysis</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Leppert, Jan</creatorcontrib><creatorcontrib>Ditz, Claudia</creatorcontrib><creatorcontrib>Souayah, Noura</creatorcontrib><creatorcontrib>Behrens, Carianne</creatorcontrib><creatorcontrib>Tronnier, Volker M.</creatorcontrib><creatorcontrib>Küchler, Jan</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>ProQuest research library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical neurology and neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Leppert, Jan</au><au>Ditz, Claudia</au><au>Souayah, Noura</au><au>Behrens, Carianne</au><au>Tronnier, Volker M.</au><au>Küchler, Jan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Limitations of prone positioning in patients with aneurysmal subarachnoid hemorrhage and concomitant respiratory failure</atitle><jtitle>Clinical neurology and neurosurgery</jtitle><addtitle>Clin Neurol Neurosurg</addtitle><date>2023-09-01</date><risdate>2023</risdate><volume>232</volume><spage>107878</spage><pages>107878-</pages><artnum>107878</artnum><issn>0303-8467</issn><issn>1872-6968</issn><eissn>1872-6968</eissn><abstract>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 < 0.001) with ICP 1 h (R: 0.57) and 4 h (R: 0.55) after onset of PP.
PP in aSAH patients with respiratory insufficiency is an effective therapeutic option improving arterial and global cerebral oxygenation without compromising CPP. The significant increase in ICP was moderate in most sessions. However, as some patients experience intolerable ICP crises during PP, continuous ICP-Monitoring is considered mandatory. Patients with elevated baseline ICP and reduced intracranial compliance should not be considered for PP.
•Prone positioning improves cerebral oxygenation in SAH patients.•Prone positioning significantly increases ICP in SAH patients.•Medically refractory ICP crisis occur in about 5% of proning sessions.•‘Younger age’ might pose a risk factors for medically refractory ICP crisis.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>37423091</pmid><doi>10.1016/j.clineuro.2023.107878</doi><orcidid>https://orcid.org/0000-0002-2925-8537</orcidid></addata></record> |
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| 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 Stroke Subarachnoid hemorrhage Variance analysis Ventilators |
| title | Limitations of prone positioning in patients with aneurysmal subarachnoid hemorrhage and concomitant respiratory failure |
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