Myles D Boone1, Sayuri P Jinadasa2, Ariel Mueller2, Shahzad Shaefi2, Ekkehard M Kasper3, Khalid A Hanafy4, Brian P O'Gara2, Daniel S Talmor2. 1. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. mboone@bidmc.harvard.edu. 2. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. 3. Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. 4. Department of Neurology, Division of Neurocritical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND: Lung protective ventilation has not been evaluated in patients with brain injury. It is unclear whether applying positive end-expiratory pressure (PEEP) adversely affects intracranial pressure (ICP) and cerebral perfusion pressure (CPP). We aimed to evaluate the effect of PEEP on ICP and CPP in a large population of patients with acute brain injury and varying categories of acute lung injury, defined by PaO2/FiO2. METHOD: Retrospective data were collected from 341 patients with severe acute brain injury admitted to the ICU between 2008 and 2015. These patients experienced a total of 28,644 paired PEEP and ICP observations. Demographic, hemodynamic, physiologic, and ventilator data at the time of the paired PEEP and ICP observations were recorded. RESULTS: In the adjusted analysis, a statistically significant relationship between PEEP and ICP and PEEP and CPP was found only among observations occurring during periods of severe lung injury. For every centimeter H2O increase in PEEP, there was a 0.31 mmHg increase in ICP (p = 0.04; 95 % CI [0.07, 0.54]) and a 0.85 mmHg decrease in CPP (p = 0.02; 95 % CI [-1.48, -0.22]). CONCLUSION: Our results suggest that PEEP can be applied safely in patients with acute brain injury as it does not have a clinically significant effect on ICP or CPP. Further prospective studies are required to assess the safety of applying a lung protective ventilation strategy in brain-injured patients with lung injury.
BACKGROUND: Lung protective ventilation has not been evaluated in patients with brain injury. It is unclear whether applying positive end-expiratory pressure (PEEP) adversely affects intracranial pressure (ICP) and cerebral perfusion pressure (CPP). We aimed to evaluate the effect of PEEP on ICP and CPP in a large population of patients with acute brain injury and varying categories of acute lung injury, defined by PaO2/FiO2. METHOD: Retrospective data were collected from 341 patients with severe acute brain injury admitted to the ICU between 2008 and 2015. These patients experienced a total of 28,644 paired PEEP and ICP observations. Demographic, hemodynamic, physiologic, and ventilator data at the time of the paired PEEP and ICP observations were recorded. RESULTS: In the adjusted analysis, a statistically significant relationship between PEEP and ICP and PEEP and CPP was found only among observations occurring during periods of severe lung injury. For every centimeter H2O increase in PEEP, there was a 0.31 mmHg increase in ICP (p = 0.04; 95 % CI [0.07, 0.54]) and a 0.85 mmHg decrease in CPP (p = 0.02; 95 % CI [-1.48, -0.22]). CONCLUSION: Our results suggest that PEEP can be applied safely in patients with acute brain injury as it does not have a clinically significant effect on ICP or CPP. Further prospective studies are required to assess the safety of applying a lung protective ventilation strategy in brain-injured patients with lung injury.
Authors: Matthias Briel; Maureen Meade; Alain Mercat; Roy G Brower; Daniel Talmor; Stephen D Walter; Arthur S Slutsky; Eleanor Pullenayegum; Qi Zhou; Deborah Cook; Laurent Brochard; Jean-Christophe M Richard; Francois Lamontagne; Neera Bhatnagar; Thomas E Stewart; Gordon Guyatt Journal: JAMA Date: 2010-03-03 Impact factor: 56.272
Authors: Imoigele P Aisiku; Jose-Miguel Yamal; Pratik Doshi; Maria Laura Rubin; Julia S Benoit; Julia Hannay; Barbara C Tilley; Shankar Gopinath; Claudia S Robertson Journal: J Trauma Acute Care Surg Date: 2016-02 Impact factor: 3.313
Authors: V Marco Ranieri; Gordon D Rubenfeld; B Taylor Thompson; Niall D Ferguson; Ellen Caldwell; Eddy Fan; Luigi Camporota; Arthur S Slutsky Journal: JAMA Date: 2012-06-20 Impact factor: 56.272
Authors: Fred Rincon; Sayantani Ghosh; Saugat Dey; Mitchell Maltenfort; Matthew Vibbert; Jacqueline Urtecho; William McBride; Michael Moussouttas; Rodney Bell; John K Ratliff; Jack Jallo Journal: Neurosurgery Date: 2012-10 Impact factor: 4.654
Authors: Jason L Siegel; Karen Hampton; Alejandro A Rabinstein; Diane McLaughlin; Jose L Diaz-Gomez Journal: Neurocrit Care Date: 2018-12 Impact factor: 3.210