Effects of positive end-expiratory pressure on intracranial pressure and compliance in brain-injured patients

View More View Less
  • 1 Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, New York
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

✓ Hypoxic pulmonary disorders and head injuries associated with increased intracranial pressure (ICP) frequently co-exist. Positive end-expiratory pressure (PEEP) improves hypoxemia but has been reported to impede cerebral venous return, potentially causing a further increase in ICP. This study examined the effects of PEEP on ICP at different levels of brain compliance.

Continuous ICP recordings were obtained after insertion of Scott cannulas to the lateral ventricles of seven comatose patients. Brain compliance was assessed by calculation of the pressure volume index. Patients were maintained in a 30° head-up position. Maintenance of PEEP to levels of 40 cm H2O pressure for as long as 18 hours did not increase ICP in patients with either normal or low intracranial compliance, and did not increase ICP in the absence of pulmonary disease. Central venous pressure and pulmonary artery wedge pressure increased proportionately as PEEP was increased. No consistent changes were found in blood pressure recordings, nor were there any reductions in cardiac output found during the studies. Abrupt discontinuation of PEEP did not result in increased ICP except for a transient rise on two occasions when respiratory secretions became copious and the patients were inadequately ventilated. Improved oxygenation in two patients as a result of PEEP was concomitant with improved intracranial compliance and neurological status.

In patients with brain injuries, PEEP improves arterial oxygenation without increasing ICP as previously supposed. Consequently, PEEP is a valuable form of therapy for the comatose patient with pulmonary disorders such as pneumonia or pulmonary edema.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1.

    Aidinis SJ, , Shapiro HM, & Van Horn K: Effects of positive end-expiratory pressure (PEEP) on intracranial pressure, sagittal sinus and cerebral perfusion pressures during experimental intracranial hypertension in cat. Proceedings of the American Association of Neurological Surgeons, 43rd Annual Meeting, April, 1975, p 94 (Abstract 58) Aidinis SJ, Shapiro HM, Van Horn K: Effects of positive end-expiratory pressure (PEEP) on intracranial pressure, sagittal sinus and cerebral perfusion pressures during experimental intracranial hypertension in cat. Proceedings of the American Association of Neurological Surgeons, 43rd Annual Meeting, April, 1975, p 94 (Abstract 58)

    • Search Google Scholar
    • Export Citation
  • 2.

    Bashour FA: Effect of intermittent positive pressure breathing on cardiac output and splanchnic blood flow. Inhal Ther 13:4752, 1968 Bashour FA: Effect of intermittent positive pressure breathing on cardiac output and splanchnic blood flow. Inhal Ther 13:47–52, 1968

    • Search Google Scholar
    • Export Citation
  • 3.

    Cuypers J, , Matakas F, & Potolicchio SJ: Effects of central venous pressure on brain tissue pressure and brain volume. J Neurosurg 45:8994, 1976 Cuypers J, Matakas F, Potolicchio SJ: Effects of central venous pressure on brain tissue pressure and brain volume. J Neurosurg 45:89–94, 1976

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Hobelmann CF Jr, , Smith DE, & Virgilio RW, et al: Hemodynamic alterations with positive end-expiratory pressure: the contribution of the pulmonary vasculature. J Trauma 15:951959, 1975 Hobelmann CF Jr, Smith DE, Virgilio RW, et al: Hemodynamic alterations with positive end-expiratory pressure: the contribution of the pulmonary vasculature. J Trauma 15:951–959, 1975

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Kumar A, , Falke KJ, & Geffin B, et al: Continuous positive pressure ventilation in acute respiratory failure. Effects on hemodynamics and lung function. N Engl J Med 283:14301436, 1970 Kumar A, Falke KJ, Geffin B, et al: Continuous positive pressure ventilation in acute respiratory failure. Effects on hemodynamics and lung function. N Engl J Med 283:1430–1436, 1970

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Marmarou A, , Shulman K, & LaMorgese J: Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J Neurosurg 43:523534, 1975 Marmarou A, Shulman K, LaMorgese J: Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J Neurosurg 43:523–534, 1975

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Marmarou A, & Tayyab A: Unpublished data Marmarou A, Tayyab A: Unpublished data

  • 8.

    Marx GF, , Andrews IC, & Orkin LR: Cerebrospinal fluid pressures during halothane anesthesia. Can Anaesth Soc J 9:239245, 1962 Marx GF, Andrews IC, Orkin LR: Cerebrospinal fluid pressures during halothane anesthesia. Can Anaesth Soc J 9:239–245, 1962

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Petty TL: Improvement of oxygenation in the adult respiratory distress syndrome by PEEP. Respir Care 16:173176, 1971 Petty TL: Improvement of oxygenation in the adult respiratory distress syndrome by PEEP. Respir Care 16:173–176, 1971

    • Search Google Scholar
    • Export Citation
  • 10.

    Schettini A, , McKay L, & Mahig J, et al: The response of brain surface pressure to hypercapnic hypoxia and hyperventilation. Anesthesiology 36:412, 1972 Schettini A, McKay L, Mahig J, et al: The response of brain surface pressure to hypercapnic hypoxia and hyperventilation. Anesthesiology 36:4–12, 1972

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Swan HJC, & Ganz W: Use of balloon flotation catheters in critically ill patients. Surg Clin North Am 55 No 3: 501520, 1975 Swan HJC, Ganz W: Use of balloon flotation catheters in critically ill patients. Surg Clin North Am 55 No 3:501–520, 1975

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1246 569 164
Full Text Views 272 15 0
PDF Downloads 173 24 0
EPUB Downloads 0 0 0