Prone Positioning in Neurocritical Care Patients with Invasive Intracranial Pressure Monitoring: A Systematic Review and Meta-analysis.

IF 4.2 3区医学 Q2 CLINICAL NEUROLOGY

Neurocritical Care Pub Date : 2026-10-07 DOI:10.1007/s12028-026-02667-0

Annika Meyer, Remco Overbeek, Laura Mühlhausen, Jan Küchler, Claudia Ditz, André Foit, Marion Hof, Roland Goldbrunner, Andrea U Steinbicker

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Abstract

Background: Pulmonary complications are common after acute brain injury and may worsen neurologic outcomes. Although prone positioning (PP) is an established treatment strategy for acute respiratory distress syndrome (ARDS) with severe hypoxemia in general intensive care unit populations, it is often avoided in neurocritical care due to concerns that PP may increase intracranial pressure (ICP). However, evidence supporting these concerns remains limited.

Methods: A systematic search of multiple databases and supplementary sources using keywords related to ICP and PP yielded 778 records. Ten studies with 177 patients met the inclusion criteria for the systematic review and eight (n = 120 patients) provided extractable data for meta-analysis of the primary outcome [change in ICP from baseline (supine) to PP]. Pooled means and mean differences were calculated using random-effects models.

Results: The pooled within-subject mean change in ICP from baseline to PP was + 5.06 mm Hg (95% CI 2.05-8.06; I² = 76.7%). Accordingly, pooled mean ICP increased from 11.10 mm Hg (95% CI 8.43-13.76) at baseline to 16.13 mm Hg (95% CI 13.83-18.43) during PP, remaining below commonly used treatment thresholds for intracranial hypertension although clinically relevant ICP elevations occurred in a small subset of patients. By contrast, the pooled change in ICP between baseline and after returning to the supine position in five studies (n = 45) was - 0.41 mm Hg (95% CI - 2.34 to 1.51), indicating that the increase in ICP during PP was transient and reversible. Systemic oxygenation and brain tissue oxygenation improved in PP.

Conclusions: In patients with acute brain injury, PP improves systemic and brain tissue oxygenation while causing a modest, transient increase in ICP that resolves after resupination. These findings support cautious use of PP in selected neurocritical care patients with respiratory failure when invasive ICP monitoring is available. Given the limited evidence base, larger prospective studies are needed.

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有创颅内压监测中神经危重症患者俯卧位：系统回顾和meta分析。

背景：急性脑损伤后肺部并发症很常见，并可能使神经系统预后恶化。虽然俯卧位（PP）是普通重症监护病房人群中急性呼吸窘迫综合征（ARDS）伴严重低氧血症的一种成熟治疗策略，但由于担心俯卧位可能会增加颅内压（ICP），因此在神经危重症护理中经常避免使用。然而，支持这些担忧的证据仍然有限。方法：系统检索多个数据库和补充资料，使用ICP和PP相关的关键词，得到778条记录。10项共177例患者的研究符合系统评价的纳入标准，8项（n = 120例）为主要结局（ICP从基线（仰卧位）到PP的变化）的meta分析提供了可提取的数据。采用随机效应模型计算合并均值和均值差异。结果：受试者内ICP从基线到PP的平均变化为+ 5.06 mm Hg （95% CI 2.05-8.06; I2 = 76.7%）。因此，在PP期间，汇总平均ICP从基线时的11.10 mm Hg （95% CI 8.43-13.76）增加到16.13 mm Hg (95% CI 13.83-18.43)，尽管临床上相关的ICP升高发生在一小部分患者中，但仍低于颅内高压常用的治疗阈值。相比之下，在5项研究（n = 45）中，基线和恢复仰卧位后ICP的总变化为- 0.41 mm Hg (95% CI - 2.34至1.51)，表明PP期间ICP的增加是短暂的和可逆的。结论：在急性脑损伤患者中，PP改善了全身氧合和脑组织氧合，同时引起中度的、短暂的颅内压升高，并在复血后消退。这些发现支持在有创性ICP监测的神经危重症呼吸衰竭患者谨慎使用PP。鉴于证据基础有限，需要更大规模的前瞻性研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurocritical Care 医学-临床神经学

CiteScore

7.40

自引率

8.60%

发文量

221

审稿时长

4-8 weeks

期刊介绍： Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.