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 (SjvO 2 ), brain tissue partial pressure of oxygen (PbtO 2 ), and arteriovenous difference of oxygen (AVDO 2 ) are uncertain. Our objective was to evaluate the effects of head elevation on ICP, CPP, SjvO 2 , PbtO 2 , and AVDO 2 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, SjvO 2 , PbtO 2 , and AVDO 2 . 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