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Intensive Care Medicine

, Volume 32, Issue 12, pp 1947–1954 | Cite as

Respiratory mechanics in brain-damaged patients

  • Antonia KoutsoukouEmail author
  • Helen Perraki
  • Asimina Raftopoulou
  • Nikolaos Koulouris
  • Christina Sotiropoulou
  • Anastasia Kotanidou
  • Stylianos Orfanos
  • Charis Roussos
Original

Abstract

Objective

To assess respiratory mechanics on the 1st and 5th days of mechanical ventilation in a cohort of brain-damaged patients on positive end-expiratory pressure (PEEP) of 8 cmH2O or zero PEEP (ZEEP).

Design and setting

Physiological study with randomized control trial design in a multidisciplinary intensive care unit of a university hospital.

Patients and measurements

Twenty-one consecutive mechanically ventilated patients with severe brain damage and no acute lung injury were randomly assigned to be ventilated with ZEEP (n = 10) or with 8 cmH2O of PEEP (n = 11). Respiratory mechanics and arterial blood gases were assessed on days 1 and day 5 of mechanical ventilation.

Results

In the ZEEP group on day 1 static elastance and minimal resistance were above normal limits (18.9 ± 3.8 cmH2O/l and 5.6 ± 2.2 cmH2O/l per second, respectively); on day 5 static elastance and iso-CO2 minimal resistance values were higher than on day 1 (21.2 ± 4.1 cmH2O/l; 7.0 ± 1.9 cmH2O/l per second, respectively). In the PEEP group these parameters did not change significantly. One of the ten patients on ZEEP developed acute lung injury. On day 5 there was a significant decrease in PaO2/FIO2 in both groups.

Conclusions

On day 1 of mechanical ventilation patients with brain damage exhibit abnormal respiratory mechanics. After 5 days of mechanical ventilation on ZEEP static elastance and minimal resistance increased significantly, perhaps reflecting “low lung volume” injury. Both could be prevented by administration of moderate levels of PEEP.

Keywords

Mechanical ventilation Head injury Hypocapnic bronchoconstriction Ventilator-induced lung injury 

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Antonia Koutsoukou
    • 1
    Email author
  • Helen Perraki
    • 1
  • Asimina Raftopoulou
    • 1
  • Nikolaos Koulouris
    • 1
  • Christina Sotiropoulou
    • 1
  • Anastasia Kotanidou
    • 1
  • Stylianos Orfanos
    • 1
  • Charis Roussos
    • 1
  1. 1.Department of Critical Care and Pulmonary Services, Evangelismos General Hospital and M. Simou Laboratory, Medical SchoolUniversity of AthensAthensGreece

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