Evaluation of the efficacy of prone position therapy in patients with acute brain Injury: A prospective observational study

• Study Objective: This prospective observational study investigates the efficacy of prone position (PP) therapy in patients with acute brain injury (ABI) complicated by severe lung injury. • Patient Population: Nine patients with ABI requiring mechanical ventilation were enrolled, undergoing a total of 13 episodes of PP therapy. • Key Findings: Intracranial pressure (ICP) increased significantly during PP, but remained below critical levels. • Peripheral oxygen saturation and lung ultrasound scores improved significantly post-therapy, indicating enhanced oxygenation and pulmonary function. • Seven patients showed improved pulmonary imaging outcomes, and clinical recovery was noted in most participants. • Complications: Six patients experienced complications related to PP therapy, including ocular issues and pressure ulcers, but no severe complications were observed. • Conclusion: PP therapy is effective and safe for ABI patients with concurrent severe lung injury, highlighting the need for continuous monitoring to ensure patient safety and optimize outcomes. • Future Directions: Larger multicenter studies are recommended to validate these findings and explore the long-term impact of PP therapy on neurological and pulmonary recovery. Acute brain injury (ABI) frequently coexists with severe lung injury, leading to significant challenges. This study investigates the impact of prone position (PP) on the patients with ABI. This prospective observational study was conducted at Huashan Hospital, enrolling patients with ABI requiring mechanical ventilation. ICP and ABP were continuously monitored. PP therapy was initiated based on clinical assessments. We evaluated ICP, CPP, oxygenation, and hemodynamics at three time points: baseline (T0), during therapy (T1), and after therapy (T2). LUS, CT, and ABG were performed. The primary outcomes included imaging results and clinical endpoints, while secondary outcomes focused on complications related to PP. Nine patients with ABI were enrolled, with a total of 13 episodes of PP analyzed. ICP notably elevated (14.8 ± 5.5 mmHg vs. 20.7 ± 6.0 mmHg, P < 0.05). No significant changes in CPP were observed across T0, T1, and T2; however, oxygen saturation significantly improved during PP. LUS decreased significantly from T0 to T2 (8.60 ± 3.50 vs. 20.80 ± 3.71, P < 0.001). Seven patients displayed improved pulmonary imaging. One patient recovered fully, 7 showed improvement, and 1 succumbed. Complications related to PP were recorded in 6 patients, including two cases of ocular complications and five pressure ulcers. This study underscores the efficacy and safety of PP in patients with ABI complicated by severe lung injury. Continuous multimodal monitoring of neurological status during the intervention is crucial. Further research with larger sample is necessary to validate these findings and enhance patient outcomes.