Effect of positive end expiratory pressure ventilation on intracranial pressure in man

Michael L. J. Apuzzo Department of Surgery, Division of Neurosurgery, University of Southern California School of Medicine, Los Angeles, California

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Martin H. Weiss Department of Surgery, Division of Neurosurgery, University of Southern California School of Medicine, Los Angeles, California

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Viesturs Petersons Department of Surgery, Division of Neurosurgery, University of Southern California School of Medicine, Los Angeles, California

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R. Baldwin Small Department of Surgery, Division of Neurosurgery, University of Southern California School of Medicine, Los Angeles, California

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Theodore Kurze Department of Surgery, Division of Neurosurgery, University of Southern California School of Medicine, Los Angeles, California

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James S. Heiden Department of Surgery, Division of Neurosurgery, University of Southern California School of Medicine, Los Angeles, California

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Page Range:
227–232
Volume/Issue:
Volume 46: Issue 2
DOI link:
https://doi.org/10.3171/jns.1977.46.2.0227
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✓ This study was designed to define the effect of positive end expiratory pressure (PEEP) ventilation on intracranial pressure (ICP). In 25 patients with severe head trauma with and without associated pulmonary injury the following parameters were simultaneously monitored under mechanical ventilation with and without PEEP: ICP, arterial blood pressure, central venous pressure, arterial blood gases, and cardiac rate. In addition, the volume-pressure response (VPR) was evaluated in each patient to assess cerebral elastance. The results indicate a significant increase in ICP with the application of PEEP only in the 12 patients who manifested increased cerebral elastance by VPR. Half of this latter group manifested impairment of cerebral perfusion pressure to levels less than 60 mm Hg. Return to baseline ICP levels was observed with termination of PEEP. No significantly consistent changes in other parameters were noted.

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Contributor Notes

Address reprint requests to: Michael L. J. Appuzzo, M.D., Los Angeles County-University of Southern California Medical Center, 1200 North State Street, Suite 5046, Los Angeles, California 90033.
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