Document Detail


Influence of PEEP on Cerebral Blood Flow and Cerebrovascular Autoregulation in Patients With Acute Respiratory Distress Syndrome.
MedLine Citation:
PMID:  23211642     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: High levels of positive end-expiratory pressure (PEEP), as part of the treatment in patients with acute respiratory distress syndrome (ARDS), may prevent alveolar collapse and maintain oxygenation. PEEP potentially reduces cerebral venous return, increases intracranial blood volume, and may, therefore, affect cerebral blood flow (CBF) and cerebrovascular autoregulation (AR). This study investigates the effect of PEEP on CBF and AR in patients with respiratory failure. METHODS:: CBF velocity was measured using transcranial doppler and correlated with the invasive arterial blood pressure curve to calculate the index of AR Mx (Mx>0.3 indicates impaired AR). Mx was measured at lower PEEP levels and after increasing PEEP. Only an increase of Mx of >0.2 was considered to be clinically relevant. Two 1-sided Wilcoxon tests. RESULTS:: Twenty mechanically ventilated patients with ARDS were included. Elevation of PEEP from 9.2±1 to 14.3±1 cm H2O did not influence CBF velocity but increased Mx from 0.317±0.35 to 0.414±0.32 (difference ≤0.2). Mx was >0.3 in 11/20 patients during baseline measurements, indicating impaired AR. CONCLUSIONS:: Surprisingly, AR was impaired in 55% of the patients with ARDS. This should be taken into account when managing cerebral perfusion pressure to avoid cerebral hyperperfusion or hypoperfusion. Increasing PEEP from 9.2 to 14.3 cm H2O had no further clinically relevant effect on AR, independent of preexisting AR impairment.
Authors:
Patrick Schramm; Dorothea Closhen; Matthias Felkel; Manfred Berres; Klaus U Klein; Matthias David; Christian Werner; Kristin Engelhard
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-30
Journal Detail:
Title:  Journal of neurosurgical anesthesiology     Volume:  -     ISSN:  1537-1921     ISO Abbreviation:  J Neurosurg Anesthesiol     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-12-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8910749     Medline TA:  J Neurosurg Anesthesiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
*Department of Anesthesiology †Institute of Medical Biometry, Epidemiology and Informatics (IMBEI), University Medical Centre, Johannes Gutenberg-University Mainz, Mainz ‡Department of Mathematics and Technology, RheinAhrCampus Remagen, Remagen, Germany §Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Vienna General Hospital, University Vienna, Wien, Austria.
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