Evidence map›Paper›PMID 40133757›Full record

ArticleNeurocritical care2025

Effects of 'Head Up' Prone Position on Transcranial Color Doppler-Based Estimators of Intracranial Pressure in Moderate to Severe Acute Respiratory Distress Syndrome Without Brain Injury: A Cross-Over, Longitudinal, Physiological Study.

Domenico Junior Brunetti, Francesca Leonardis, Francesca Frisardi, Mario Dauri, Cristian Deana, Raffaele Aspide, Gianmaria Cammarota, Luigi Pisani, Rossella Adorno, Roberto Polidoro and 5 more

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Article in Neurocritical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–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

3 citing papers in PubMed.

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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

15 authors.

Domenico Junior BrunettiIntensive Care Unit, Tor Vergata' University Hospital, Rome, Italy.
Francesca LeonardisIntensive Care Unit, Tor Vergata' University Hospital, Rome, Italy.
Francesca FrisardiIntensive Care Unit, Tor Vergata' University Hospital, Rome, Italy.
Mario DauriDepartment of Clinical Science and Translational Medicine, 'Tor Vergata' University of Rome, Rome, Italy.
Cristian DeanaDepartment of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy.
Raffaele AspideAnesthesia and Neurointensive Care Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
Gianmaria CammarotaDepartment of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy.
Luigi PisaniDepartment of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy.
Rossella AdornoIntensive Care Unit, Tor Vergata' University Hospital, Rome, Italy.
Roberto PolidoroIntensive Care Unit, Tor Vergata' University Hospital, Rome, Italy.
Marco TiseoIntensive Care Unit, Tor Vergata' University Hospital, Rome, Italy.
Paola Giuseppina SergiIntensive Care Unit, Tor Vergata' University Hospital, Rome, Italy.
Luigi VetrugnoDepartment of Medical, Oral, and Biotechnological Sciences, University G. D'Annunzio, Chieti, Italy.
Luciana MasciaUniSalento University, Lecce, Italy.
Daniele Guerino BiasucciDepartment of Clinical Science and Translational Medicine, 'Tor Vergata' University of Rome, Rome, Italy. danielebiasucci@gmail.com.ORCID 0000-0001-6839-2416

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundProne positioning is recommended in acute respiratory distress syndrome (ARDS) to ensure adequate gas exchange. However, it may lead to an increase in intracranial pressure (ICP), mostly due to a reduction of venous return from the brain. ICP can be noninvasively estimated with transcranial color-coded Doppler (TCCD) using methods based on the relationships between the pulsatility index (PI) and ICP or methods based on the estimate of cerebral perfusion pressure (eCPP) and estimate of ICP (eICP). This study was aimed at assessing the effects of a 30° reverse Trendelenburg ('head up') prone position on two noninvasive estimators of ICP (eICP and PI).

methodsThis is a cross-over, longitudinal, physiological study conducted on a cohort of adult patients fulfilling Berlin definition criteria for moderate to severe ARDS without brain injury but with clinical indication to prone positioning. We registered TCCD parameters of cerebral hemodynamic and systemic hemodynamic parameters, blood gas exchange data, and respiratory mechanics parameters in a horizonal supine position, in a 30° semirecumbent supine position, in the standard prone position, and, finally, in the 30° 'head up' prone position, obtained by tilting the entire bed to a reverse Trendelenburg position. One-way repeated measures analysis of variance was used to analyze data.

resultsIn 20 patients included, switching from a supine position to the standard prone position resulted in a significant increase in mean ± SD PI (from 0.99 ± 0.22 to 1.29 ± 0.25, p < 0.01) and eICP (from 12.5 ± 3.8 to 17.5 ± 4.1, p < 0.01), whereas moving from this latter position to the 'head up' prone position resulted in a decrease in the mean ± SD PI (from 1.29 ± 0.25 to 1.0 ± 0.23, p < 0.01). Hemodynamic and respiratory mechanics parameters did not differ.

conclusionsThe 30° 'head up' prone position may limit the increase in PI in moderate to severe ARDS without brain injury. As a noninvasive estimator of ICP, PI may allow detection of changes in ICP when moving from the 'head up' semirecumbent supine position to the standard prone position and from this latter position to the 'head up' prone position.

Indexed as

Cerebrovascular CirculationIntracranial PressurePatient PositioningRespiratory Distress SyndromeUltrasonography, Doppler, TranscranialAdultAgedCross-Over StudiesFemaleHead-Down TiltHumansLongitudinal StudiesMaleMiddle AgedProne PositionSupine PositionAcute respiratory distress syndromeIntracranial pressureMechanical powerProne positionPulsatility indexTranscranial color-coded DopplerTranscranial Doppler

Identifiers

PMID40133757

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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.