Document Detail


Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: the role of respiratory system compliance.
MedLine Citation:
PMID:  15761353     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Positive end-expiratory pressure (PEEP) can be effective in improving oxygenation, but it may worsen or induce intracranial hypertension. The authors hypothesized that the intracranial effects of PEEP could be related to the changes in respiratory system compliance (Crs). METHODS: A prospective study investigated 21 comatose patients with severe head injury or subarachnoid hemorrhage receiving intracranial pressure (ICP) monitoring who required mechanical ventilation and PEEP. The 13 patients with normal Crs were analyzed as group A and the 8 patients with low Crs as group B. During the study, 0, 5, 8, and 12 cm H2O of PEEP were applied in a random sequence. Jugular pressure, central venous pressure (CVP), cerebral perfusion pressure (CPP), intracranial pressure (ICP), cerebral compliance, mean velocity of the middle cerebral arteries, and jugular oxygen saturation were evaluated simultaneously. RESULTS: In the group A patients, the PEEP increase from 0 to 12 cm H2O significantly increased CVP (from 10.6 +/- 3.3 to 13.8 +/- 3.3 mm Hg; p < 0.001) and jugular pressure (from 16.6 +/- 3.1 to 18.8 +/- 3.2 mm Hg; p < 0.001), but reduced mean arterial pressure (from 96.3 +/- 6.7 to 91.3 +/- 6.5 mm Hg; p < 0.01), CPP (from 82.2 +/- 6.9 to 77.0 +/- 6.2 mm Hg; p < 0.01), and mean velocity of the middle cerebral arteries (from 73.1 +/- 27.9 to 67.4 +/- 27.1 cm/sec; F = 7.15; p < 0.001). No significant variation in these parameters was observed in group B patients. After the PEEP increase, ICP and cerebral compliance did not change in either group. Although jugular oxygen saturation decreased slightly, it in no case dropped below 50%. CONCLUSIONS: In patients with low Crs, PEEP has no significant effect on cerebral and systemic hemodynamics. Monitoring of Crs may be useful for avoiding deleterious effects of PEEP on the intracranial system of patients with normal Crs.
Authors:
Anselmo Caricato; Giorgio Conti; Francesco Della Corte; Aldo Mancino; Federico Santilli; Claudio Sandroni; Rodolfo Proietti; Massimo Antonelli
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of trauma     Volume:  58     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  2005 Mar 
Date Detail:
Created Date:  2005-03-11     Completed Date:  2005-04-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  571-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesia and Intensive Care, Catholic University School of Medicine, Policlinico A. Gemelli, Rome, Italy. anselmo.caricato@fastwebnet.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Analysis of Variance
Blood Flow Velocity
Blood Pressure
Central Venous Pressure
Cerebral Arteries / physiopathology
Cerebrovascular Circulation
Craniocerebral Trauma* / physiopathology,  therapy
Female
Glasgow Coma Scale
Hemodynamics
Humans
Intracranial Hypertension / etiology,  prevention & control
Intracranial Pressure
Jugular Veins / physiopathology
Lung Compliance*
Male
Middle Aged
Monitoring, Physiologic / methods
Positive-Pressure Respiration* / adverse effects,  methods
Prospective Studies
Respiratory Mechanics
Subarachnoid Hemorrhage* / physiopathology,  therapy
Treatment Outcome

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