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Neurocritical Care

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01-06-2016 | Original Article

Intracranial Pressure During Pressure Control and Pressure-Regulated Volume Control Ventilation in Patients with Traumatic Brain Injury: A Randomized Crossover trial

Authors: Kari Schirmer-Mikalsen, Anne Vik, Eirik Skogvoll, Kent Gøran Moen, Ole Solheim, Pål Klepstad

Published in: Neurocritical Care | Issue 3/2016

Abstract

Introduction

Mechanical ventilation with control of partial arterial CO₂ pressures (PaCO₂) is used to treat or stabilize intracranial pressure (ICP) in patients with traumatic brain injury (TBI). Pressure-regulated volume control (PRVC) is a ventilator mode where inspiratory pressures are automatically adjusted to deliver the patient a pre-set stable tidal volume (TV). This may result in a more stable PaCO₂ and thus a more stable ICP compared with conventional pressure control (PC) ventilation. The aim of this study was to compare PC and PRVC ventilation in TBI patients with respect to ICP and PaCO₂.

Methods

This is a randomized crossover trial including eleven patients with a moderate or severe TBI who were mechanically ventilated and had ICP monitoring. Each patient was administered alternating 2-h periods of PC and PRVC ventilation. The outcome variables were ICP and PaCO₂.

Results

Fifty-two (26 PC, 26 PRVC) study periods were included. Mean ICP was 10.8 mmHg with PC and 10.3 mmHg with PRVC ventilation (p = 0.38). Mean PaCO₂ was 36.5 mmHg (4.87 kPa) with PC and 36.1 mmHg (4.81 kPa) with PRVC (p = 0.38). There were less fluctuations in ICP (p = 0.02) and PaCO₂ (p = 0.05) with PRVC ventilation.

Conclusions

Mean ICP and PaCO₂ were similar for PC and PRVC ventilation in TBI patients, but PRVC ventilation resulted in less fluctuation in both ICP and PaCO₂. We cannot exclude that the two ventilatory modes would have impact on ICP in patients with higher ICP values; however, the similar PaCO₂ observations argue against this.

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Title: Intracranial Pressure During Pressure Control and Pressure-Regulated Volume Control Ventilation in Patients with Traumatic Brain Injury: A Randomized Crossover trial
Authors: Kari Schirmer-Mikalsen
Anne Vik
Eirik Skogvoll
Kent Gøran Moen
Ole Solheim
Pål Klepstad
Publication date: 01-06-2016
Publisher: Springer US
Published in: Neurocritical Care / Issue 3/2016
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-015-0208-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intracranial Pressure During Pressure Control and Pressure-Regulated Volume Control Ventilation in Patients with Traumatic Brain Injury: A Randomized Crossover trial

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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