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01-04-2017 | Original Article

The Effect of Positive End-Expiratory Pressure on Intracranial Pressure and Cerebral Hemodynamics

Authors: Myles D. Boone, Sayuri P. Jinadasa, Ariel Mueller, Shahzad Shaefi, Ekkehard M. Kasper, Khalid A. Hanafy, Brian P. O’Gara, Daniel S. Talmor

Published in: Neurocritical Care | Issue 2/2017

Abstract

Background

Lung protective ventilation has not been evaluated in patients with brain injury. It is unclear whether applying positive end-expiratory pressure (PEEP) adversely affects intracranial pressure (ICP) and cerebral perfusion pressure (CPP). We aimed to evaluate the effect of PEEP on ICP and CPP in a large population of patients with acute brain injury and varying categories of acute lung injury, defined by PaO₂/FiO₂.

Method

Retrospective data were collected from 341 patients with severe acute brain injury admitted to the ICU between 2008 and 2015. These patients experienced a total of 28,644 paired PEEP and ICP observations. Demographic, hemodynamic, physiologic, and ventilator data at the time of the paired PEEP and ICP observations were recorded.

Results

In the adjusted analysis, a statistically significant relationship between PEEP and ICP and PEEP and CPP was found only among observations occurring during periods of severe lung injury. For every centimeter H₂O increase in PEEP, there was a 0.31 mmHg increase in ICP (p = 0.04; 95 % CI [0.07, 0.54]) and a 0.85 mmHg decrease in CPP (p = 0.02; 95 % CI [−1.48, −0.22]).

Conclusion

Our results suggest that PEEP can be applied safely in patients with acute brain injury as it does not have a clinically significant effect on ICP or CPP. Further prospective studies are required to assess the safety of applying a lung protective ventilation strategy in brain-injured patients with lung injury.

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Title: The Effect of Positive End-Expiratory Pressure on Intracranial Pressure and Cerebral Hemodynamics
Authors: Myles D. Boone
Sayuri P. Jinadasa
Ariel Mueller
Shahzad Shaefi
Ekkehard M. Kasper
Khalid A. Hanafy
Brian P. O’Gara
Daniel S. Talmor
Publication date: 01-04-2017
Publisher: Springer US
Published in: Neurocritical Care / Issue 2/2017
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-016-0328-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The Effect of Positive End-Expiratory Pressure on Intracranial Pressure and Cerebral Hemodynamics

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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