PulmPEEPs 95. Clinical Pearl: Prone Positioning with Elevated Intracranial Pressure
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Feb 25, 2025 Dr. Jon Rosenberg, an assistant professor at Westchester Medical Center and neurocritical care expert, joins to tackle the surprising flexibility of prone positioning for patients with elevated intracranial pressure (ICP). He debunks the myth that elevated ICP is an absolute contraindication to proning. The discussion emphasizes careful patient selection and shares successful case examples, especially during COVID-19. Practical tips for ensuring cerebral perfusion while managing potential complications are also highlighted, making this a must-listen for critical care professionals.
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Elevated ICP and Proning
- Elevated intracranial pressure (ICP) is often considered a contraindication to proning, but it's more of a relative caution.
- Neuro ICUs now prone patients with elevated ICP, especially after managing both respiratory failure and neurological conditions during the pandemic.
Patient Selection for Proning
- Consider proning for patients with elevated ICP and respiratory failure, including those with global cerebral edema or focal lesions.
- Hemodynamic instability and morbid obesity are bigger concerns than ICP itself when considering proning.
Theoretical Concerns with Proning
- Proning can make neurological exams difficult due to sedation and patient positioning.
- It can also compress jugular veins, obstruct CSF flow, and potentially increase ICP.