Effects of positive end-expiratory pressure on brain tissue oxygen pressure of severe traumatic brain injury patients with acute respiratory distress syndrome: A pilot study

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• 作者：Sé ; rgio Nogueira Nemer ; PT ; PhD^a ; ^b ; ^c ; ^{snnemer@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Jefferson B. Caldeira ; PT ; MsC^a ; ^c ; Ricardo G. Santos ; PT^a ; Bruno L. Guimarã ; es ; PT^a ; Joã ; o Má ; rcio Garcia ; MD ; PhD^a ; Darwin Prado ; MD^a ; Ricardo T. Silva ; MD^a ; Leandro M. Azeredo ; PT ; MsC^b ; Eduardo R. Faria ; PT^a ; Paulo Cesar P. Souza ; MD^a
• 关键词：Mechanical ventilation ; Acute respiratory distress syndrome ; Brain injury
• 刊名：Journal of Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：30
• 期：6
• 页码：1263-1266
• 全文大小：468 K

文摘

To verify whether high positive end-expiratory pressure levels can increase brain tissue oxygen pressure, and also their effects on pulse oxygen saturation, intracranial pressure, and cerebral perfusion pressure.

Material and Methods

Twenty traumatic brain injury patients with acute respiratory distress syndrome were submitted to positive end-expiratory pressure levels of 5, 10, and 15 cm H₂O progressively. The 3 positive end-expiratory pressure levels were used during 20 minutes for each one, whereas brain tissue oxygen pressure, oxygen saturation, intracranial pressure, and cerebral perfusion pressure were recorded.

Results

Brain tissue oxygen pressure and oxygen saturation increased significantly with increasing positive end-expiratory pressure from 5 to 10 and from 10 to 15 cm H₂O (P = .0001 and P = .0001 respectively). Intracranial pressure and cerebral perfusion pressure did not differ significantly with increasing positive end-expiratory pressure from 5 to 10 and from 10 to 15 cm H₂O (P = .16 and P = .79 respectively).

Conclusions

High positive end-expiratory pressure levels increased brain tissue oxygen pressure and oxygen saturation, without increase in intracranial pressure or decrease in cerebral perfusion pressure. High positive end-expiratory pressure levels can be used in severe traumatic brain injury patients with acute respiratory distress syndrome as a safe alternative to improve brain oxygenation.