Abstract
The effect of up to 15 cm H2O positive end-expiratory pressure (PEEP) on cerebrospinal fluid pressure (Pcsf) was investigated in five anaesthetised, mechanically ventilated dogs during normal and then elevated (40–50 cm H2O) intracranial pressure (ICP). Stepwise elevations of PEEP in 5 cm H2O increments resulted in small rises in Pcsf at normal ICP and in significantly larger rises when ICP was elevated. The regression equations for the relationships between Pcsf and end-expiratory pressure (EEP) were as follows: Pcsf=12.95+0.82 EEP for normal ICP, and Pcsf=46.41+2.06 EEP for elevated ICP. Mean PaCO2 rose from 39.7±2.5 to 47.6±5.0 torr during normal ICP, and from 34.2±2.9 to 50.9±5.3 torr at elevated ICP as PEEP was elevated to 15 cm H2O. We conclude that PEEP raised Pcsf, and that this increase is more severe under conditions of elevated ICP. The rise in Pcsf due to PEEP may be explained by either the rise in intrathoracic pressure or the rise in PaCO2, or both.
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Aidinis SJ, Lafferty J, Shapiro HM (1976) Intracranial response to PEEP. Anesthesiology 45:275
Alexander SC, Lassen NA (1970) Cerebral circulatory response to acute brain disease: implications for anesthetic practice. Anesthesiology 32:60
Apuzzo MLJ, Weiss MH, Petersons V, Small B, Kurze Y, Heiden JS (1977) Effect of positive end expiratory pressure ventilation on intracranial pressure in man. J Neurosurg 46:227
Ashbaugh DG, Petty TL (1973) Positive end-expiratory pressure. J Thorac Cardiovasc Surg 65:165
Chapin JC, Downs JB, Douglas ME, Murphy EJ, Ruiz BC (1979) Lung expansion, airway pressure transmission and positive end-expiratory pressure. Arch Surg 114:1193
Cotev S, Perel A, Katzenelson R, Eimerl D (1976) The effect of PEEP on oxygenating capacity in acute respiratory failure with sepsis. Crit Care Med 4:186
Downs JB, Perkins HM, Modell JH (1974) Intermittent mandatory ventilation. An evaluation. Arch Surg 109:519
Downs JB (1976) A technique for direct measurement of intrapleural pressure. Crit Care Med 4:207
Frost EAM (1977) Effects of positive end-expiratory pressure on intracranial pressure and compliance in brain-injured patients. J Neurosurg 47:195
Huseby JS, Pavlin EG, Butler J (1978) Effect of positive end-expiratory pressure on intracranial pressure in dogs. J Appl Physiol 44:25
James HE, Tsueda K, Wright B, Young AB, McCloskey J (1978) The effect of positive end-expiratory pressure (PEEP) ventilation in neurogenic pulmonary oedema. Acta Neurochir 43:275
Kirby RR, Downs JB, Civetta JM, Modell JH, Dannemiller FJ, Klein EF, Hodges M (1975) High level positive end expiratory pressure (PEEP) in acute respiratory insufficiency. Chest 67:156
Kumar A, Falke KJ, Geffin B, Aldridge CF, Laver MB, Lowenstein E, Pontoppidan H (1970) Continuous positivepressure ventilation in acute respiratory failure. N Engl J Med 283:1430
Maxwell JA, Goodwin JW (1973) Neurogenic pulmonary shunting. J Trauma 13:368
Miller JD, Stanek AB, Langfit TW (1973) Cerebral blood flow regulation during experimental brain compression. J Neurosurg 39:186
Moss G, Staunton C, Stein AA (1972) Cerebral etiology of the “shock lung syndrome”. J Trauma 12:885
Powers SR Jr (1974) The use of positive end-expiratory pressure (PEEP) for respiratory support. Surg Clin N Am 54:1125
Shapiro HM (1975) Intracranial hypertension: therapeutic and anesthetic considerations. Anesthesiology 43:445
Smith AL, Wollman H (1972) Cerebral blood flow and metabolism: Effects of anesthetic drugs and technique. Anesthesiology 36:378
Theodore J, Robin ED (1976) Speculation on neurogenic pulmonary edema (NPE). Am Rev Respir Dis 113:405
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Dedicated to Professor Dr. Johannes Linzbach, Göttingen, on the occasion of his 70th birthday
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Cotev, S., Paul, W.L., Ruiz, B.C. et al. Positive end-expiratory pressure (PEEP) and cerebrospinal fluid pressure during normal and elevated intracranial pressure in dogs. Intensive Care Med 7, 187–191 (1981). https://doi.org/10.1007/BF01724839
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DOI: https://doi.org/10.1007/BF01724839