Sérgio Nogueira Nemer1, Jefferson B Caldeira2, Ricardo G Santos3, Bruno L Guimarães3, João Márcio Garcia3, Darwin Prado3, Ricardo T Silva3, Leandro M Azeredo4, Eduardo R Faria3, Paulo Cesar P Souza3. 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.
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 injurypatients 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 injurypatients with acute respiratory distress syndrome as a safe alternative to improve brain oxygenation.
Authors: Antonia Koutsoukou; Maria Katsiari; Stylianos E Orfanos; Anastasia Kotanidou; Maria Daganou; Magdalini Kyriakopoulou; Nikolaos G Koulouris; Nikoletta Rovina Journal: World J Crit Care Med Date: 2016-02-04