Airway pressure release ventilation does not increase intracranial pressure in patients with traumatic brain injury with poor lung compliance

Edgerton, Colston; Leon, Stuart; Hite, Melissa; Kalhorn, Stephen P.; Scott, L; Eriksson, Evert A.

doi:10.1016/j.jcrc.2018.11.034

Cited by 9 publications

(4 citation statements)

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“…Two retrospective case series and our own experience of using APRV in hypoxaemic patients with TBI and ICP monitoring already in situ have not shown a detrimental effect on ICP, and improved arterial oxygenation can often reduce a raised ICP. 21,22 In addition to the avoidance of hypoxaemia, the maintenance of normocarbia is important when treating intracranial hypertension, and it may not be safe to tolerate permissive hypercarbia associated with a pH >7.2 in these patients. Our own practice is to note the minute volume with conventional ventilation required to maintain the target arterial carbon dioxide tension before switching to APRV, and then immediately titrate settings to maintain this minute volume.…”

Section: Neurocritical Carementioning

confidence: 99%

Airway pressure release ventilation

2020

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Section: Neurocritical Carementioning

confidence: 99%

Airway pressure release ventilation

2020

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“…This increase in CVP from this mode of ventilation does not affect ICP or hemodynamic parameters. [27] In this study, it was found that there was no relationship between GCS scores and CVP values, which may be because there are other factors besides GCS that affect CVP. Several organ systems regulate CVP.…”

Section: Demographic Characteristicsmentioning

confidence: 65%

“…This increase in CVP from this mode of ventilation does not affect ICP or hemodynamic parameters. [27]…”

Section: Discussionmentioning

confidence: 99%

Correlation between Glasgow Coma Scale with central venous pressure and near-infrared spectroscopy in patients with acquired brain injury in the intensive care unit of Adam Malik Hospital Medan

Nasution¹,

Lubis²

2023

Emerg Crit Care Med

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BackgroundAcquired brain injury (ABI) is caused by trauma or nontrauma to the brain after birth. Increased intracranial pressure in patients with traumatic or nontraumatic brain injury affects the cerebral perfusion pressure. After traumatic brain injury, there is an increase in air content in the brain and an increase in volume of blood flow to the brain, which can cause increased intracranial pressure, herniation of brain tissue, impaired cerebral perfusion, and brain damage. Most patients with traumatic brain injury die from uncontrolled increases in intracranial pressure. Near-infrared spectroscopy (NIRS) and central venous pressure (CVP) monitoring are also associated with cerebral perfusion. This study aimed to determine the relationship between the Glasgow Coma Scale (GCS) scores and CVP and NIRS values in patients with ABI.MethodsThis prospective analytical study used a cross-sectional design to compare GCS scores with CVP and NIRS values in patients with traumatic and nontraumatic brain injury in the intensive care unit (ICU) of Haji Adam Malik Hospital Medan. GCS, CVP, and NIRS descriptive data in patients with brain injury were presented in terms of mean and standard deviation if the data were normally distributed, or median (interquartile range) values if the data were not normally distributed. The relationship between GCS scores and CVP and NIRS values was assessed using the Pearson correlation test if the data were normally distributed, or the Spearman test if the data were not normally distributed.ResultsIn this study, the mean GCS score and CVP values were 7.04 ± 2.69 and 5.63 ± 25.82 mmHg, respectively. The right tissue oxygen saturation (StO2) was 55.61% ± 18.72%, and the left StO2 was 57.57% ± 17.48% with normally distributed data. There was no correlation between GCS scores and CVP values (P = 0.829), and no correlation between moderate GCS scores and right and left StO2 (P = 0.343; P = 0.121); however, there was a significantly strong positive correlation between severe GCS scores and right and left StO2 (P = 0.028, r = 0.656; P = 0.005, r = 0.777).ConclusionThere was no significant correlation between GCS scores and CVP values, and no correlation between moderate GCS scores and NIRS values; however, there was a significantly strong positive correlation between severe GCS scores and NIRS values in patients with ABI at the ICU of Haji Adam Malik Hospital Medan.

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“…In 2012, Paul et al [69] showed that APRV can be safely and effectively applied to patients with severe neurological diseases and can increase cerebral blood flow without increasing intracranial pressure (ICP), which was confirmed in a similar study by Fletcher et al [70] in 2018. Similarly, Edgerton et al [71] retrospectively studied the effects of APRV in 15 patients with traumatic brain injury. In this study, ICP did not significantly change after the transition to APRV.…”

Section: Effects Of Aprv On Extrapulmonary Organsmentioning

confidence: 99%