• Intensive care medicine · Mar 2005

    Randomized Controlled Trial Clinical Trial

    Cerebro-pulmonary interactions during the application of low levels of positive end-expiratory pressure.

    • Luciana Mascia, Salvatore Grasso, Tommaso Fiore, Francesco Bruno, Maurizio Berardino, and Alessandro Ducati.
    • Università di Torino, Dipartimento di Discipline Medico-Chirurgiche, Sezione di Anestesiologia e Rianimazione, Ospedale S. Giovanni Battista, Italy. luciana.mascia@unito.it
    • Intensive Care Med. 2005 Mar 1;31(3):373-9.

    ObjectiveIn patients with severe brain injury and acute lung injury the use of positive end-expiratory pressure (PEEP) is limited by conflicting results on its effect on intracranial pressure. We hypothesised that the occurrence of alveolar hyperinflation during the application of PEEP would lead to an increase in PaCO(2) responsible for a rise in intracranial pressure.DesignProspective interventional study.SettingIntensive Care Unit of University Hospitals.Patients And ParticipantsTwelve severely brain-injured patients with acute lung injury and intracranial pressure higher than applied PEEP.Interventions5 and 10 cmH(2)O of PEEP was randomly applied.Measurements And ResultsIn all patients intracranial pressure, flow velocity by transcranial Doppler of middle cerebral artery, and jugular oxygen saturation were recorded. Static volume-pressure curves of the respiratory system were obtained, recruited volume and elastance calculated to classify patients as recruiters and non-recruiters. In recruiters (= 6 patients), elastance decreased (P<0.01) and PaO(2) increased (P<0.005), while in non-recruiters (= 6 patients) elastance and PaCO(2) significantly increased (P<0.001). Intracranial pressure, Doppler flow velocity, and jugular saturation remained constant in recruiters but significantly increased (P<0.0001) in non-recruiters. A significant correlation was found between changes in intracranial pressure and elastance (r(2) = 0.8 P<0.0001) and between changes in PaCO(2) and intracranial pressure (P<0.001, r(2) = 0.4) and elastance (P<0.001, r(2) = 0.4), respectively.ConclusionsWhen PEEP induced alveolar hyperinflation leading to a significant increase in PaCO(2), intracranial pressure significantly increased, whereas when PEEP caused alveolar recruitment intracranial pressure did not change.

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