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J Crit Care. 2015 Dec;30(6):1263-6. doi: 10.1016/j.jcrc.2015.07.019. Epub 2015 Jul 26.

Effects of positive end-expiratory pressure on brain tissue oxygen pressure of severe traumatic brain injury patients with acute respiratory distress syndrome: A pilot study.

Author information

1
Complexo Hospitalar de Niterói. Rua La Salle 12, Centro, Niterói, Rio de Janeiro, CEP: 24020-090, Brazil; Hospital da Polícia Militar de Niterói. Rua Martins Torres 245, Santa Rosa, Niterói, Rio de Janeiro, CEP: 24240-705, Brazil; Universidade UNIGRANRIO. Rua José de Souza Herdy 1160, Jardim Vinte e Cinco de Agosto, Duque de Caxias, CEP: 25071-202, Brazil. Electronic address: snnemer@gmail.com.
2
Complexo Hospitalar de Niterói. Rua La Salle 12, Centro, Niterói, Rio de Janeiro, CEP: 24020-090, Brazil; Universidade UNIGRANRIO. Rua José de Souza Herdy 1160, Jardim Vinte e Cinco de Agosto, Duque de Caxias, CEP: 25071-202, Brazil.
3
Complexo Hospitalar de Niterói. Rua La Salle 12, Centro, Niterói, Rio de Janeiro, CEP: 24020-090, Brazil.
4
Hospital da Polícia Militar de Niterói. Rua Martins Torres 245, Santa Rosa, Niterói, Rio de Janeiro, CEP: 24240-705, Brazil.

Abstract

PURPOSE:

To verify whether high positive end-expiratory pressure levels can increase brain tissue oxygen pressure, and also their effects on pulse oxygen saturation, intracranial pressure, and cerebral perfusion pressure.

MATERIAL AND METHODS:

Twenty traumatic brain injury patients with acute respiratory distress syndrome were submitted to positive end-expiratory pressure levels of 5, 10, and 15 cm H2O progressively. The 3 positive end-expiratory pressure levels were used during 20 minutes for each one, whereas brain tissue oxygen pressure, oxygen saturation, intracranial pressure, and cerebral perfusion pressure were recorded.

RESULTS:

Brain tissue oxygen pressure and oxygen saturation increased significantly with increasing positive end-expiratory pressure from 5 to 10 and from 10 to 15 cm H2O (P=.0001 and P=.0001 respectively). Intracranial pressure and cerebral perfusion pressure did not differ significantly with increasing positive end-expiratory pressure from 5 to 10 and from 10 to 15 cm H2O (P=.16 and P=.79 respectively).

CONCLUSIONS:

High positive end-expiratory pressure levels increased brain tissue oxygen pressure and oxygen saturation, without increase in intracranial pressure or decrease in cerebral perfusion pressure. High positive end-expiratory pressure levels can be used in severe traumatic brain injury patients with acute respiratory distress syndrome as a safe alternative to improve brain oxygenation.

KEYWORDS:

Acute respiratory distress syndrome; Brain injury; Mechanical ventilation

PMID:
26307004
DOI:
10.1016/j.jcrc.2015.07.019
[Indexed for MEDLINE]

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