Intensive Care Medicine

, Volume 31, Issue 3, pp 373–379

Cerebro-pulmonary interactions during the application of low levels of positive end-expiratory pressure

  • Luciana Mascia
  • Salvatore Grasso
  • Tommaso Fiore
  • Francesco Bruno
  • Maurizio Berardino
  • Alessandro Ducati
Original

Abstract

Objective

In patients with severe brain injury and acute lung injury the use of positive end-expiratory pressure (PEEP) is limited by conflicting results on its effect on intracranial pressure. We hypothesised that the occurrence of alveolar hyperinflation during the application of PEEP would lead to an increase in PaCO2 responsible for a rise in intracranial pressure.

Design

Prospective interventional study.

Setting

Intensive Care Unit of University Hospitals.

Patients and participants

Twelve severely brain-injured patients with acute lung injury and intracranial pressure higher than applied PEEP.

Interventions

5 and 10 cmH2O of PEEP was randomly applied.

Measurements and results

In all patients intracranial pressure, flow velocity by transcranial Doppler of middle cerebral artery, and jugular oxygen saturation were recorded. Static volume-pressure curves of the respiratory system were obtained, recruited volume and elastance calculated to classify patients as recruiters and non-recruiters. In recruiters (= 6 patients), elastance decreased (P<0.01) and PaO2 increased (P<0.005), while in non-recruiters (= 6 patients) elastance and PaCO2 significantly increased (P<0.001). Intracranial pressure, Doppler flow velocity, and jugular saturation remained constant in recruiters but significantly increased (P<0.0001) in non-recruiters. A significant correlation was found between changes in intracranial pressure and elastance (r2 = 0.8 P<0.0001) and between changes in PaCO2 and intracranial pressure (P<0.001, r2 = 0.4) and elastance (P<0.001, r2 = 0.4), respectively.

Conclusions

When PEEP induced alveolar hyperinflation leading to a significant increase in PaCO2, intracranial pressure significantly increased, whereas when PEEP caused alveolar recruitment intracranial pressure did not change.

Keywords

Brain injury Acute lung injury Positive end-expiratory pressure Intracranial pressure 

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Luciana Mascia
    • 1
  • Salvatore Grasso
    • 2
  • Tommaso Fiore
    • 3
  • Francesco Bruno
    • 3
  • Maurizio Berardino
    • 4
  • Alessandro Ducati
    • 5
  1. 1.Università di Torino, Dipartimento di Discipline Medico-Chirurgiche, Sezione di Anestesiologia e RianimazioneOspedale S. Giovanni BattistaTorinoItaly
  2. 2.Servizio di Anestesiologia e RianimazioneOspedale Di VenereBariItaly
  3. 3.Sezione di Anestesiologia e Rianimazione, Dipartimento di Emergenza e Trapianti d’Organo, Università di BariOspedale PoliclinicoBariItaly
  4. 4.Servizio di Neuroanestesia e RianimazioneOspedale S. Giovanni BattistaTorinoItaly
  5. 5.Sezione di Neurochirurgia, Dipartimento di Neuroscienze, Università di TorinoOspedale S. Giovanni BattistaTorinoItaly

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