Miguel Bertelli Ramos, João Pedro Einsfeld Britz, João Paulo Mota Telles, Gabriela Borges Nager, Giulia Isadora Cenci, Carla Bittencourt Rynkowski, Manoel Jacobsen Teixeira, Eberval Gadelha Figueiredo
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Our objective was to evaluate the effects of head elevation on ICP, CPP, SjvO<sub>2</sub>, PbtO<sub>2</sub>, and AVDO<sub>2</sub> among patients with acute brain injury.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis on PubMed, Scopus, and Cochrane Library of studies comparing the effects of different degrees of head elevation on ICP, CPP, SjvO<sub>2</sub>, PbtO<sub>2</sub>, and AVDO<sub>2</sub>.</p><p><strong>Results: </strong>A total of 25 articles were included in the systematic review. Of these, 16 provided quantitative data regarding outcomes of interest and underwent meta-analyses. The mean ICP of patients with acute brain injury was lower in group with 30° of head elevation than in the supine position group (mean difference [MD] - 5.58 mm Hg; 95% confidence interval [CI] - 6.74 to - 4.41 mm Hg; p < 0.00001). The only comparison in which a greater degree of head elevation did not significantly reduce the ICP was 45° vs. 30°. The mean CPP remained similar between 30° of head elevation and supine position (MD - 2.48 mm Hg; 95% CI - 5.69 to 0.73 mm Hg; p = 0.13). Similar findings were observed in all other comparisons. The mean SjvO<sub>2</sub> was similar between the 30° of head elevation and supine position groups (MD 0.32%; 95% CI - 1.67% to 2.32%; p = 0.75), as was the mean PbtO<sub>2</sub> (MD - 1.50 mm Hg; 95% CI - 4.62 to 1.62 mm Hg; p = 0.36), and the mean AVDO<sub>2</sub> (MD 0.06 µmol/L; 95% CI - 0.20 to 0.32 µmol/L; p = 0.65).The mean ICP of patients with traumatic brain injury was also lower with 30° of head elevation when compared to the supine position. There was no difference in the mean values of mean arterial pressure, CPP, SjvO<sub>2</sub>, and PbtO<sub>2</sub> between these groups.</p><p><strong>Conclusions: </strong>Increasing degrees of head elevation were associated, in general, with a lower ICP, whereas CPP and brain oxygenation parameters remained unchanged. The severe traumatic brain injury subanalysis found similar results.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"950-962"},"PeriodicalIF":3.1000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Effects of Head Elevation on Intracranial Pressure, Cerebral Perfusion Pressure, and Cerebral Oxygenation Among Patients with Acute Brain Injury: A Systematic Review and Meta-Analysis.\",\"authors\":\"Miguel Bertelli Ramos, João Pedro Einsfeld Britz, João Paulo Mota Telles, Gabriela Borges Nager, Giulia Isadora Cenci, Carla Bittencourt Rynkowski, Manoel Jacobsen Teixeira, Eberval Gadelha Figueiredo\",\"doi\":\"10.1007/s12028-024-02020-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Head elevation is recommended as a tier zero measure to decrease high intracranial pressure (ICP) in neurocritical patients. However, its quantitative effects on cerebral perfusion pressure (CPP), jugular bulb oxygen saturation (SjvO<sub>2</sub>), brain tissue partial pressure of oxygen (PbtO<sub>2</sub>), and arteriovenous difference of oxygen (AVDO<sub>2</sub>) are uncertain. Our objective was to evaluate the effects of head elevation on ICP, CPP, SjvO<sub>2</sub>, PbtO<sub>2</sub>, and AVDO<sub>2</sub> among patients with acute brain injury.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis on PubMed, Scopus, and Cochrane Library of studies comparing the effects of different degrees of head elevation on ICP, CPP, SjvO<sub>2</sub>, PbtO<sub>2</sub>, and AVDO<sub>2</sub>.</p><p><strong>Results: </strong>A total of 25 articles were included in the systematic review. Of these, 16 provided quantitative data regarding outcomes of interest and underwent meta-analyses. The mean ICP of patients with acute brain injury was lower in group with 30° of head elevation than in the supine position group (mean difference [MD] - 5.58 mm Hg; 95% confidence interval [CI] - 6.74 to - 4.41 mm Hg; p < 0.00001). The only comparison in which a greater degree of head elevation did not significantly reduce the ICP was 45° vs. 30°. The mean CPP remained similar between 30° of head elevation and supine position (MD - 2.48 mm Hg; 95% CI - 5.69 to 0.73 mm Hg; p = 0.13). Similar findings were observed in all other comparisons. The mean SjvO<sub>2</sub> was similar between the 30° of head elevation and supine position groups (MD 0.32%; 95% CI - 1.67% to 2.32%; p = 0.75), as was the mean PbtO<sub>2</sub> (MD - 1.50 mm Hg; 95% CI - 4.62 to 1.62 mm Hg; p = 0.36), and the mean AVDO<sub>2</sub> (MD 0.06 µmol/L; 95% CI - 0.20 to 0.32 µmol/L; p = 0.65).The mean ICP of patients with traumatic brain injury was also lower with 30° of head elevation when compared to the supine position. There was no difference in the mean values of mean arterial pressure, CPP, SjvO<sub>2</sub>, and PbtO<sub>2</sub> between these groups.</p><p><strong>Conclusions: </strong>Increasing degrees of head elevation were associated, in general, with a lower ICP, whereas CPP and brain oxygenation parameters remained unchanged. 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引用次数: 0
摘要
背景：头部抬高被推荐为降低神经重症患者高颅内压（ICP）的一级措施。然而，其对脑灌注压（CPP）、颈静脉球氧饱和度（SjvO2）、脑组织氧分压（PbtO2）和动静脉氧差（AVDO2）的定量影响尚不确定。我们的目的是评估头部抬高对急性脑损伤患者ICP、CPP、SjvO2、PbtO2和AVDO2的影响：我们在 PubMed、Scopus 和 Cochrane Library 上对比较不同程度的头部抬高对 ICP、CPP、SjvO2、PbtO2 和 AVDO2 影响的研究进行了系统回顾和荟萃分析：共有 25 篇文章被纳入系统综述。结果：共有 25 篇文章被纳入系统综述，其中 16 篇提供了相关结果的定量数据并进行了荟萃分析。头部抬高 30° 组急性脑损伤患者的平均 ICP 低于仰卧位组（平均差 [MD] - 5.58 mm Hg；95% 置信区间 [CI] - 6.74 至 - 4.41 mm Hg；P 2），头部抬高 30° 组与仰卧位组之间的差异相似（MD 0.32%；95% CI - 1.PbtO2（MD - 1.50 mm Hg；95% CI - 4.62 to 1.62 mm Hg；p = 0.36）和AVDO2（MD 0.06 µmol/L；95% CI - 0.20 to 0.32 µmol/L；p = 0.65）的平均值也是如此。这两组患者的平均动脉压、CPP、SjvO2 和 PbtO2 的平均值没有差异：结论：一般来说，头部抬高的程度越大，ICP越低，而CPP和脑氧合参数则保持不变。严重创伤性脑损伤子分析也发现了类似的结果。
The Effects of Head Elevation on Intracranial Pressure, Cerebral Perfusion Pressure, and Cerebral Oxygenation Among Patients with Acute Brain Injury: A Systematic Review and Meta-Analysis.
Background: Head elevation is recommended as a tier zero measure to decrease high intracranial pressure (ICP) in neurocritical patients. However, its quantitative effects on cerebral perfusion pressure (CPP), jugular bulb oxygen saturation (SjvO2), brain tissue partial pressure of oxygen (PbtO2), and arteriovenous difference of oxygen (AVDO2) are uncertain. Our objective was to evaluate the effects of head elevation on ICP, CPP, SjvO2, PbtO2, and AVDO2 among patients with acute brain injury.
Methods: We conducted a systematic review and meta-analysis on PubMed, Scopus, and Cochrane Library of studies comparing the effects of different degrees of head elevation on ICP, CPP, SjvO2, PbtO2, and AVDO2.
Results: A total of 25 articles were included in the systematic review. Of these, 16 provided quantitative data regarding outcomes of interest and underwent meta-analyses. The mean ICP of patients with acute brain injury was lower in group with 30° of head elevation than in the supine position group (mean difference [MD] - 5.58 mm Hg; 95% confidence interval [CI] - 6.74 to - 4.41 mm Hg; p < 0.00001). The only comparison in which a greater degree of head elevation did not significantly reduce the ICP was 45° vs. 30°. The mean CPP remained similar between 30° of head elevation and supine position (MD - 2.48 mm Hg; 95% CI - 5.69 to 0.73 mm Hg; p = 0.13). Similar findings were observed in all other comparisons. The mean SjvO2 was similar between the 30° of head elevation and supine position groups (MD 0.32%; 95% CI - 1.67% to 2.32%; p = 0.75), as was the mean PbtO2 (MD - 1.50 mm Hg; 95% CI - 4.62 to 1.62 mm Hg; p = 0.36), and the mean AVDO2 (MD 0.06 µmol/L; 95% CI - 0.20 to 0.32 µmol/L; p = 0.65).The mean ICP of patients with traumatic brain injury was also lower with 30° of head elevation when compared to the supine position. There was no difference in the mean values of mean arterial pressure, CPP, SjvO2, and PbtO2 between these groups.
Conclusions: Increasing degrees of head elevation were associated, in general, with a lower ICP, whereas CPP and brain oxygenation parameters remained unchanged. The severe traumatic brain injury subanalysis found similar results.
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.
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