Background Prone positioning has proven clinical benefit in ARDS patients. There is clinical dilemma in patients at risk of respiratory failure with concurrent brain injury and reduced intracranial compliance who may benefit from prone positioning. Current guidelines are lacking evidence and recommendations regarding management in context of this clinical scenario. Objectives This study aimed to determine the safety and efficacy of prone positioning in mechanically ventilated adult patients with acquired brain injury using a narrative systematic review. Methods The following databases were searched: CENTRAL, MEDLINE, Cochrane, ClinicalTrials.gov, HERDIN for relevant studies from the last 20 years. Prespecified screening and eligibility criteria for inclusion were applied. Included studies underwent methodological quality assessment. Study design, patient characteristics, interventions given, and relevant outcomes were extracted and summarized. Results This review included five relevant articles – 1 randomized controlled trial (RCT) and 4 observational studies (2 retrospective case-series, 2 prospective case-series). There was a total of 114 patients included in the studies (51 from the RCT and 63 from the observational studies). The RCT was found to be of fair methodological quality, while the 4 observational studies satisfied most of the criteria of good methodological quality based on risk of bias assessment tools used. General consensus revealed improved oxygenation in mechanically ventilated ABI patients with Level 4 evidence, but may increase ICP levels with Level 2 evidence at most. Conclusion It may be safe and effective in a carefully selected population of mechanically ventilated ABI patients if ICP monitoring is available.

mechanical ventilation

brain injury

prone