Impact of Head-of-Bed Posture on Brain Oxygenation in Patients with Acute Brain Injury: A Prospective Cohort Study
Background Therapeutic head positioning plays a role in the management of patients with acute brain injury. Although intracranial pressure (ICP) is typically lower in an upright posture than in a flat position, limited data exist concerning the effect of upright positioning on brain oxygenation and...
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| Veröffentlicht in: | Neurocritical care 2021-12, Vol.35 (3), p.662-668 |
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| description | Background
Therapeutic head positioning plays a role in the management of patients with acute brain injury. Although intracranial pressure (ICP) is typically lower in an upright posture than in a flat position, limited data exist concerning the effect of upright positioning on brain oxygenation and circulation. We sought to determine the impact of supine (0°) and semirecumbent (15° and 30°) postures on ICP, brain oxygenation, and brain circulation.
Methods
An observational cohort study was conducted between February 2012 and September 2015. Twenty-three patients with severe acute brain injury were successively observed at head elevations of 30°, 15°, and 0°. Postural-induced changes in ICP, cerebral perfusion pressure, brain tissue oxygenation pressure, and transcranial Doppler findings were simultaneously measured during three repeated experiments: 24 h after admission to the intensive care unit (exp1), 24 h later (exp2), and 96 h later (exp3). Cerebral perfusion pressure, arterial blood gases, hemoglobin content, and body temperature remained unchanged during the three experiments.
Results
Using linear random-slope mixed models, we found that during the early phase of acute brain injury (exp1), lowering the head posture from 30° to 15°, and then to 0°, was associated with a gradual mean ICP increase of 2.6 mm Hg (1.4–3.7 mm Hg;
P
|
| doi_str_mv | 10.1007/s12028-021-01240-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8312355</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2919593994</sourcerecordid><originalsourceid>FETCH-LOGICAL-c508t-3fb75f5ca663700c7d0ccf8a73c1cdfb2c793b4146393dd012038b4f9de673293</originalsourceid><addsrcrecordid>eNp9kU2P0zAQhi0EYj_gD3BAlriwB4M_45gDUrcCWqnSVgLOluPYbao2LrZT6L_HJWWBPXDyeObxO-N5AXhB8BuCsXybCMW0RpgShAnlGJFH4JIIUSGsKvL4FHOCKsXYBbhKaYMxlUqKp-CCcUaorNUliPPd3tgMg4czZ1oUPLp1LVyGlIfoYOjhbTRdD-9-HFeuN7krmXJdlsj1OcHvXV7DiR2yO4PzfjPE4zs4gcsY0t7Z3B0cnIZ1iBl-zkN7fAaeeLNN7vn5vAZfP374Mp2hxd2n-XSyQFbgOiPmGym8sKaqmMTYyhZb62sjmSW29Q21UrGGE14xxdq2bACzuuFeta6SjCp2Dd6Puvuh2bnWlnmj2ep97HYmHnUwnf630ndrvQoHXZflMCGKwM0osH7wbDZZ6FMO84KKmh5IYV-fm8XwbXAp612XrNtuTe_CkDQVxReOa0kL-uoBuglD7MsqNFVECcWU4oWiI2XLGlN0_n4CgvXJfj3ar4v9-pf9-jTFy7-_fP_kt98FYCOQSqlfufin939kfwK5Mrof</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2919593994</pqid></control><display><type>article</type><title>Impact of Head-of-Bed Posture on Brain Oxygenation in Patients with Acute Brain Injury: A Prospective Cohort Study</title><source>MEDLINE</source><source>ProQuest Central (Alumni Edition)</source><source>SpringerNature Journals</source><source>ProQuest Central UK/Ireland</source><source>ProQuest Central</source><creator>Burnol, Laetitia ; Payen, Jean-Francois ; Francony, Gilles ; Skaare, Kristina ; Manet, Romain ; Morel, Jérôme ; Bosson, Jean-Luc ; Gergele, Laurent</creator><creatorcontrib>Burnol, Laetitia ; Payen, Jean-Francois ; Francony, Gilles ; Skaare, Kristina ; Manet, Romain ; Morel, Jérôme ; Bosson, Jean-Luc ; Gergele, Laurent</creatorcontrib><description>Background
Therapeutic head positioning plays a role in the management of patients with acute brain injury. Although intracranial pressure (ICP) is typically lower in an upright posture than in a flat position, limited data exist concerning the effect of upright positioning on brain oxygenation and circulation. We sought to determine the impact of supine (0°) and semirecumbent (15° and 30°) postures on ICP, brain oxygenation, and brain circulation.
Methods
An observational cohort study was conducted between February 2012 and September 2015. Twenty-three patients with severe acute brain injury were successively observed at head elevations of 30°, 15°, and 0°. Postural-induced changes in ICP, cerebral perfusion pressure, brain tissue oxygenation pressure, and transcranial Doppler findings were simultaneously measured during three repeated experiments: 24 h after admission to the intensive care unit (exp1), 24 h later (exp2), and 96 h later (exp3). Cerebral perfusion pressure, arterial blood gases, hemoglobin content, and body temperature remained unchanged during the three experiments.
Results
Using linear random-slope mixed models, we found that during the early phase of acute brain injury (exp1), lowering the head posture from 30° to 15°, and then to 0°, was associated with a gradual mean ICP increase of 2.6 mm Hg (1.4–3.7 mm Hg;
P
< 0.001); and from 30° to 0°, an increase of 7.4 mm Hg (6.3–8.6 mm Hg;
P
< 0.001). Furthermore, brain tissue oxygenation pressure and mean blood flow velocity improved when the head posture was lowered from 30° to 0° by 1.2 mm Hg (0.2–2.3 mm Hg) and 4.1 cm/s (0.0–8.2 cm/s), respectively (both
P
< 0.05).
Conclusions
Changing the positioning of stable patients with acute brain injury resulted in opposite changes of ICP versus brain oxygenation and circulation. This information supports the concept of an individualized approach to head positioning that is based on the multimodal monitoring of brain parameters.</description><identifier>ISSN: 1541-6933</identifier><identifier>EISSN: 1556-0961</identifier><identifier>DOI: 10.1007/s12028-021-01240-1</identifier><identifier>PMID: 34312789</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Brain ; Brain Injuries - therapy ; Cerebrovascular Circulation - physiology ; Cohort analysis ; Critical Care Medicine ; Ethics ; Flow velocity ; Human health and pathology ; Humans ; Intensive ; Internal Medicine ; Intracranial Pressure - physiology ; Life Sciences ; Medicine ; Medicine & Public Health ; Neurology ; Neurosurgery ; Original Work ; Patients ; Posture - physiology ; Prospective Studies ; Review boards ; Traumatic brain injury ; Ventilators</subject><ispartof>Neurocritical care, 2021-12, Vol.35 (3), p.662-668</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2021</rights><rights>2021. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2021.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c508t-3fb75f5ca663700c7d0ccf8a73c1cdfb2c793b4146393dd012038b4f9de673293</citedby><cites>FETCH-LOGICAL-c508t-3fb75f5ca663700c7d0ccf8a73c1cdfb2c793b4146393dd012038b4f9de673293</cites><orcidid>0000-0001-5104-9718</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12028-021-01240-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2919593994?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,315,781,785,886,21390,21391,27926,27927,33532,33533,33746,33747,41490,42559,43661,43807,51321,64387,64389,64391,72471</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34312789$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-04831582$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Burnol, Laetitia</creatorcontrib><creatorcontrib>Payen, Jean-Francois</creatorcontrib><creatorcontrib>Francony, Gilles</creatorcontrib><creatorcontrib>Skaare, Kristina</creatorcontrib><creatorcontrib>Manet, Romain</creatorcontrib><creatorcontrib>Morel, Jérôme</creatorcontrib><creatorcontrib>Bosson, Jean-Luc</creatorcontrib><creatorcontrib>Gergele, Laurent</creatorcontrib><title>Impact of Head-of-Bed Posture on Brain Oxygenation in Patients with Acute Brain Injury: A Prospective Cohort Study</title><title>Neurocritical care</title><addtitle>Neurocrit Care</addtitle><addtitle>Neurocrit Care</addtitle><description>Background
Therapeutic head positioning plays a role in the management of patients with acute brain injury. Although intracranial pressure (ICP) is typically lower in an upright posture than in a flat position, limited data exist concerning the effect of upright positioning on brain oxygenation and circulation. We sought to determine the impact of supine (0°) and semirecumbent (15° and 30°) postures on ICP, brain oxygenation, and brain circulation.
Methods
An observational cohort study was conducted between February 2012 and September 2015. Twenty-three patients with severe acute brain injury were successively observed at head elevations of 30°, 15°, and 0°. Postural-induced changes in ICP, cerebral perfusion pressure, brain tissue oxygenation pressure, and transcranial Doppler findings were simultaneously measured during three repeated experiments: 24 h after admission to the intensive care unit (exp1), 24 h later (exp2), and 96 h later (exp3). Cerebral perfusion pressure, arterial blood gases, hemoglobin content, and body temperature remained unchanged during the three experiments.
Results
Using linear random-slope mixed models, we found that during the early phase of acute brain injury (exp1), lowering the head posture from 30° to 15°, and then to 0°, was associated with a gradual mean ICP increase of 2.6 mm Hg (1.4–3.7 mm Hg;
P
< 0.001); and from 30° to 0°, an increase of 7.4 mm Hg (6.3–8.6 mm Hg;
P
< 0.001). Furthermore, brain tissue oxygenation pressure and mean blood flow velocity improved when the head posture was lowered from 30° to 0° by 1.2 mm Hg (0.2–2.3 mm Hg) and 4.1 cm/s (0.0–8.2 cm/s), respectively (both
P
< 0.05).
Conclusions
Changing the positioning of stable patients with acute brain injury resulted in opposite changes of ICP versus brain oxygenation and circulation. This information supports the concept of an individualized approach to head positioning that is based on the multimodal monitoring of brain parameters.</description><subject>Brain</subject><subject>Brain Injuries - therapy</subject><subject>Cerebrovascular Circulation - physiology</subject><subject>Cohort analysis</subject><subject>Critical Care Medicine</subject><subject>Ethics</subject><subject>Flow velocity</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Intensive</subject><subject>Internal Medicine</subject><subject>Intracranial Pressure - physiology</subject><subject>Life Sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neurology</subject><subject>Neurosurgery</subject><subject>Original Work</subject><subject>Patients</subject><subject>Posture - physiology</subject><subject>Prospective Studies</subject><subject>Review boards</subject><subject>Traumatic brain injury</subject><subject>Ventilators</subject><issn>1541-6933</issn><issn>1556-0961</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kU2P0zAQhi0EYj_gD3BAlriwB4M_45gDUrcCWqnSVgLOluPYbao2LrZT6L_HJWWBPXDyeObxO-N5AXhB8BuCsXybCMW0RpgShAnlGJFH4JIIUSGsKvL4FHOCKsXYBbhKaYMxlUqKp-CCcUaorNUliPPd3tgMg4czZ1oUPLp1LVyGlIfoYOjhbTRdD-9-HFeuN7krmXJdlsj1OcHvXV7DiR2yO4PzfjPE4zs4gcsY0t7Z3B0cnIZ1iBl-zkN7fAaeeLNN7vn5vAZfP374Mp2hxd2n-XSyQFbgOiPmGym8sKaqmMTYyhZb62sjmSW29Q21UrGGE14xxdq2bACzuuFeta6SjCp2Dd6Puvuh2bnWlnmj2ep97HYmHnUwnf630ndrvQoHXZflMCGKwM0osH7wbDZZ6FMO84KKmh5IYV-fm8XwbXAp612XrNtuTe_CkDQVxReOa0kL-uoBuglD7MsqNFVECcWU4oWiI2XLGlN0_n4CgvXJfj3ar4v9-pf9-jTFy7-_fP_kt98FYCOQSqlfufin939kfwK5Mrof</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>Burnol, Laetitia</creator><creator>Payen, Jean-Francois</creator><creator>Francony, Gilles</creator><creator>Skaare, Kristina</creator><creator>Manet, Romain</creator><creator>Morel, Jérôme</creator><creator>Bosson, Jean-Luc</creator><creator>Gergele, Laurent</creator><general>Springer US</general><general>Springer Nature B.V</general><general>Springer</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>1XC</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5104-9718</orcidid></search><sort><creationdate>20211201</creationdate><title>Impact of Head-of-Bed Posture on Brain Oxygenation in Patients with Acute Brain Injury: A Prospective Cohort Study</title><author>Burnol, Laetitia ; Payen, Jean-Francois ; Francony, Gilles ; Skaare, Kristina ; Manet, Romain ; Morel, Jérôme ; Bosson, Jean-Luc ; Gergele, Laurent</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c508t-3fb75f5ca663700c7d0ccf8a73c1cdfb2c793b4146393dd012038b4f9de673293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Brain</topic><topic>Brain Injuries - therapy</topic><topic>Cerebrovascular Circulation - physiology</topic><topic>Cohort analysis</topic><topic>Critical Care Medicine</topic><topic>Ethics</topic><topic>Flow velocity</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Intensive</topic><topic>Internal Medicine</topic><topic>Intracranial Pressure - physiology</topic><topic>Life Sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neurology</topic><topic>Neurosurgery</topic><topic>Original Work</topic><topic>Patients</topic><topic>Posture - physiology</topic><topic>Prospective Studies</topic><topic>Review boards</topic><topic>Traumatic brain injury</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Burnol, Laetitia</creatorcontrib><creatorcontrib>Payen, Jean-Francois</creatorcontrib><creatorcontrib>Francony, Gilles</creatorcontrib><creatorcontrib>Skaare, Kristina</creatorcontrib><creatorcontrib>Manet, Romain</creatorcontrib><creatorcontrib>Morel, Jérôme</creatorcontrib><creatorcontrib>Bosson, Jean-Luc</creatorcontrib><creatorcontrib>Gergele, Laurent</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Neurocritical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Burnol, Laetitia</au><au>Payen, Jean-Francois</au><au>Francony, Gilles</au><au>Skaare, Kristina</au><au>Manet, Romain</au><au>Morel, Jérôme</au><au>Bosson, Jean-Luc</au><au>Gergele, Laurent</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Head-of-Bed Posture on Brain Oxygenation in Patients with Acute Brain Injury: A Prospective Cohort Study</atitle><jtitle>Neurocritical care</jtitle><stitle>Neurocrit Care</stitle><addtitle>Neurocrit Care</addtitle><date>2021-12-01</date><risdate>2021</risdate><volume>35</volume><issue>3</issue><spage>662</spage><epage>668</epage><pages>662-668</pages><issn>1541-6933</issn><eissn>1556-0961</eissn><abstract>Background
Therapeutic head positioning plays a role in the management of patients with acute brain injury. Although intracranial pressure (ICP) is typically lower in an upright posture than in a flat position, limited data exist concerning the effect of upright positioning on brain oxygenation and circulation. We sought to determine the impact of supine (0°) and semirecumbent (15° and 30°) postures on ICP, brain oxygenation, and brain circulation.
Methods
An observational cohort study was conducted between February 2012 and September 2015. Twenty-three patients with severe acute brain injury were successively observed at head elevations of 30°, 15°, and 0°. Postural-induced changes in ICP, cerebral perfusion pressure, brain tissue oxygenation pressure, and transcranial Doppler findings were simultaneously measured during three repeated experiments: 24 h after admission to the intensive care unit (exp1), 24 h later (exp2), and 96 h later (exp3). Cerebral perfusion pressure, arterial blood gases, hemoglobin content, and body temperature remained unchanged during the three experiments.
Results
Using linear random-slope mixed models, we found that during the early phase of acute brain injury (exp1), lowering the head posture from 30° to 15°, and then to 0°, was associated with a gradual mean ICP increase of 2.6 mm Hg (1.4–3.7 mm Hg;
P
< 0.001); and from 30° to 0°, an increase of 7.4 mm Hg (6.3–8.6 mm Hg;
P
< 0.001). Furthermore, brain tissue oxygenation pressure and mean blood flow velocity improved when the head posture was lowered from 30° to 0° by 1.2 mm Hg (0.2–2.3 mm Hg) and 4.1 cm/s (0.0–8.2 cm/s), respectively (both
P
< 0.05).
Conclusions
Changing the positioning of stable patients with acute brain injury resulted in opposite changes of ICP versus brain oxygenation and circulation. This information supports the concept of an individualized approach to head positioning that is based on the multimodal monitoring of brain parameters.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>34312789</pmid><doi>10.1007/s12028-021-01240-1</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-5104-9718</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Brain Brain Injuries - therapy Cerebrovascular Circulation - physiology Cohort analysis Critical Care Medicine Ethics Flow velocity Human health and pathology Humans Intensive Internal Medicine Intracranial Pressure - physiology Life Sciences Medicine Medicine & Public Health Neurology Neurosurgery Original Work Patients Posture - physiology Prospective Studies Review boards Traumatic brain injury Ventilators |
| title | Impact of Head-of-Bed Posture on Brain Oxygenation in Patients with Acute Brain Injury: A Prospective Cohort Study |
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