Evaluation of the efficacy of prone position therapy in patients with acute brain Injury: A prospective observational study

Abstract

Background

Acute brain injury (ABI) frequently coexists with severe lung injury, leading to significant challenges. This study investigates the impact of prone position (PP) on the patients with ABI.

Methods

This prospective observational study was conducted at Huashan Hospital, enrolling patients with ABI requiring mechanical ventilation. ICP and ABP were continuously monitored. PP therapy was initiated based on clinical assessments. We evaluated ICP, CPP, oxygenation, and hemodynamics at three time points: baseline (T0), during therapy (T1), and after therapy (T2). LUS, CT, and ABG were performed. The primary outcomes included imaging results and clinical endpoints, while secondary outcomes focused on complications related to PP.

Results

Nine patients with ABI were enrolled, with a total of 13 episodes of PP analyzed. ICP notably elevated (14.8 ± 5.5 mmHg vs. 20.7 ± 6.0 mmHg, P < 0.05). No significant changes in CPP were observed across T0, T1, and T2; however, oxygen saturation significantly improved during PP. LUS decreased significantly from T0 to T2 (8.60 ± 3.50 vs. 20.80 ± 3.71, P < 0.001). Seven patients displayed improved pulmonary imaging. One patient recovered fully, 7 showed improvement, and 1 succumbed. Complications related to PP were recorded in 6 patients, including two cases of ocular complications and five pressure ulcers.

Conclusion

This study underscores the efficacy and safety of PP in patients with ABI complicated by severe lung injury. Continuous multimodal monitoring of neurological status during the intervention is crucial. Further research with larger sample is necessary to validate these findings and enhance patient outcomes.