Effects of rapid chest compression technique on intracranial and cerebral perfusion pressures in acute neurocritical patients: a randomized controlled trial

Abstract

Background: Some studies refer to the increase in intracranial pressure (ICP) with chest physiotherapy techniques but without any randomized controlled trials that evaluate the safety of the manual rapid chest compression technique in patients with severe acute brain injuries on invasive mechanical ventilation. Our research question examines whether intracranial and cerebral perfusion pressures significantly change during rapid chest compression technique. Methods: A prospective, randomized, single-blinded controlled trial of acute neurocritical patients under mechanical ventilation was performed. The intervention group was subjected to rapid chest compression, and the control group received mechanical passive inferior limbs mobilization. The outcomes were intracranial pressure, cerebral perfusion pressure, blood partial pressure of oxygen and carbon dioxide, and inspiratory and expiratory peak flows. Results: Between May 2021 and December 2023, 50 patients (aged 56.3 years), 66% females, were randomized into two groups (25 controls and 25 interventions). The ICP and cerebral perfusion pressure (CPP) did not significantly differ between the groups at any of the studied times. Intragroup analysis revealed significant decreases in the ICP and CPP in the intervention group, with posterior recovery in both groups. The CPP significantly decreased in the control group but did not reach the preintervention values at the last measurement time. PaCO2 was significantly lower in the intervention group than in the control group at the end of the study. Conclusion: The rapid chest compression technique did not increase the ICP during its application or even 30 min after it. The ICP showed a slight significant decrease during the application of the rapid chest compression technique but reached the previous values in the posterior 30 min. CPP had a similar behavior but did not completely recover in both groups. Trial registration: NCT03609866. Registered on 08/01/2018.