Evidence map›Paper›PMID 38886326›Full record

SynthesisNeurocritical care2024

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.

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

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Neurocritical care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Article
  4. Article
  5. Review
  6. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Miguel Bertelli RamosDepartment Neurosurgery, Hospital Do Servidor Público Estadual de São Paulo, São Paulo, Brazil.
João Pedro Einsfeld BritzDepartment of Neurosurgery, Hospital Cristo Redentor, Grupo Hospitalar Conceição, Porto Alegre, Brazil.
João Paulo Mota TellesDepartment of Neurology, University of São Paulo, São Paulo, Brazil.
Gabriela Borges NagerSchool of Medicine, Universidade Federal Do Estado Do Rio de Janeiro, Rio de Janeiro, Brazil.
Giulia Isadora CenciSchool of Medicine, Faculdade Meridional, Passo Fundo, Brazil.
Carla Bittencourt RynkowskiIntensive Care Unit, Hospital Cristo Redentor, Porto Alegre, Brazil.
Manoel Jacobsen TeixeiraDivision of Neurosurgery, School of Medicine, University of São Paulo, São Paulo, Brazil.
Eberval Gadelha FigueiredoDivision of Neurosurgery, School of Medicine, University of São Paulo, São Paulo, Brazil. ebgadelha@yahoo.com.ORCID 0000-0001-7754-4178

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHead 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

methodsWe 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

resultsA 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

conclusionsIncreasing 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.

Indexed as

Brain InjuriesCerebrovascular CirculationIntracranial PressurePatient PositioningHumansIntracranial HypertensionOxygenOxygen SaturationOxygenArteriovenous difference of oxygenBrain oxygenationBrain tissue partial pressure of oxygenCerebral hemodynamicsCerebral perfusion pressureHead elevationHead-of-bedHead positionIntracranial pressureJugular bulb oxygen saturationMeta-analysisSystematic review

Identifiers

PMID38886326

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.