Effects of positive end-expiratory pressure on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation*

Muench, Elke; Bauhuf, Christian; Roth, Harry; Horn, Peter A.; Phillips, Marc; Marquetant, Natali; Quintel, Michael; Vajkoczy, Peter

doi:10.1097/01.ccm.0000181732.37319.df

Cited by 165 publications

(110 citation statements)

References 20 publications

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“…In fact, after a certain readjustment, or "buffering" period, ICP appeared to fall to previous levels despite hypercapnea, as long as PaCO 2 was stable. This reflects work previously showing ICP and PaCO 2 relationships in both animals and humans [3,10,14]. Another reasonable concern is the possible detrimental relationship between ICP and the sustained high mean airway pressures (mP aw ) necessary for HFOV.…”

Section: Discussionsupporting

confidence: 77%

“…Another reasonable concern is the possible detrimental relationship between ICP and the sustained high mean airway pressures (mP aw ) necessary for HFOV. There are numerous papers on the effect of positive end expiratory pressure (PEEP) on ICP, and it is common practice not to employ high levels of PEEP in patients with intracranial hypertension [4,7,10]. The sustained mean airway pressure used during HFOV may be viewed by some clinicians as high PEEP; however, we did not find any significant harmful effect of these pressures in our patients.…”

Section: Discussioncontrasting

confidence: 53%

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Use of High Frequency Oscillatory Ventilation (HFOV) in Neurocritical Care Patients

et al. 2007

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Introduction-Adult respiratory distress syndrome (ARDS) can be a common problem associated with the treatment of acute brain injury. High frequency oscillatory ventilation (HFOV) is a developing therapy for the treatment of ARDS in adult patients that can be life saving. However, often patients with acute, severe brain injury demonstrate intracranial hypertension (hICP) due to a variety of injuries (e.g., traumatic brain injury, mass lesion, acute hydrocephalus). There is concern over the use of HFOV due to its effects on intracranial pressure in patients with hICP.

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Section: Discussionsupporting

confidence: 77%

Section: Discussioncontrasting

confidence: 53%

Use of High Frequency Oscillatory Ventilation (HFOV) in Neurocritical Care Patients

et al. 2007

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“…In an earlier study, high levels of PEEP were found to have an indirect effect on cerebral perfusion [4]. Luz et al [12] demonstrated that when PEEP was added to pneumoperitoneum, mean arterial pressure and cardiac output decreased more prominently than after pneumoperitoneum alone during laparoscopic pelvic lymphadenectomy in dogs.…”

Section: Discussionmentioning

confidence: 97%

Effects of high positive end‐expiratory pressure on haemodynamics and cerebral oxygenation during pneumoperitoneum in the Trendelenburg position

Lee

et al. 2013

Anaesthesia

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SummaryWe investigated the effects of 10 cmH 2 O positive end-expiratory pressure on cerebral haemodynamics and cerebral oxygenation in patients undergoing laparoscopic lower abdominal surgery in the 30°Trendelenburg position during desflurane anaesthesia. Twenty-six patients were enrolled in this study. After anaesthesia induction, pneumoperitoneum was applied in Trendelenburg position. Twenty minutes later, positive end-expiratory pressure was applied. There was no change in regional cerebral oxygen saturation (p = 0.376). Cerebral perfusion pressure decreased significantly over time (p < 0.001) and positive end-expiratory pressure caused a further decrease in cerebral perfusion pressure (p = 0.036). The application of 10 cmH 2 O positive end-expiratory pressure during pneumoperitoneum in the Trendelenburg position preserved regional cerebral oxygen saturation, but cerebral perfusion pressure decreased significantly due to its secondary haemodynamic effects.

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“…The importance of PEEP application for maintaining adequate gas exchange while preventing ventilator-induced lung injury is especially emphasized (7,10,22,23). Many studies suggested that PEEP and the alveolar recruitment maneuver application improved ventilation-perfusion and gas exchange (7,24,25).…”

Section: Discussionmentioning

confidence: 99%

“…However, PEEP application causes a subsequent elevation of intrathoracic pressure, decreases cerebral venous return, increases intracranial blood volume and pressure, and possibly impairs cerebral blood flow. The effects of PEEP on ICP and cerebral perfusion pressure (CPP) have been the focus of several experimental and clinical studies, but these studies did not address the direct relationship between ICP, cerebral blood flow, and PEEP during steep Trendelenburg position combined with pneumoperitoneum (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Effects of positive end-expiratory pressure on intracranial pressure during pneumoperitoneum and Trendelenburg position in a porcine model*

Bedirli¹,

Emmez²,

Ünal³

et al. 2017

Turk J Med Sci

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IntroductionRobot-assisted laparoscopic surgery has developed greatly and is becoming a standard technique for radical prostatectomy. It is widely preferred for pelvic surgeries because of its important advantages that minimize postoperative morbidity and mortality. Robotic surgeries in the pelvic region, including radical prostatectomy, rectum resection, and gynecologic procedures, usually require a steep Trendelenburg position and carbon dioxide pneumoperitoneum to secure the surgical field. Pneumoperitoneum combined with steep Trendelenburg position may cause significant changes in cardiovascular, respiratory, and neurophysiological parameters (1,2). Both the increase in abdominal pressure as a result of carbon dioxide insufflation and the head-down position have been shown to impair respiratory functions during the procedure by pushing the diaphragm upward and reducing lung volume and respiratory compliance, thus inducing atelectasis formation (3,4).Background/aim: This study was undertaken to evaluate the effects of positive end-expiratory pressure (PEEP) levels on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) and to determine the appropriate PEEP level during steep Trendelenburg position combined with pneumoperitoneum. Materials and methods:Ten pigs were included in this study. Pneumoperitoneum and Trendelenburg position were maintained and PEEP titration was initiated. Arterial pressure, heart rate, arterial blood gas, ICP, and CPP were recorded at the following time points: baseline (T0), 30 min after positioning and pneumoperitoneum (T1), PEEP 5 (T2), PEEP 10 (T3), PEEP 15 (T4), and PEEP 20 (T5).Results: MAP significantly increased at T1 compared to T0 and decreased at T4 and T5 compared to T1. ICP was 9.5 mmHg and CPP was 69.3 mmHg at T0. CO 2 insufflation and steep Trendelenburg position did not cause any significant difference in ICP and CPP. ICP increased and CPP decreased significantly at T4 and T5 compared to both T0 and T1. PaO 2 and PaO 2 /FiO 2 decreased significantly at T1 and T2 compared to T0, while both increased significantly at T3, T4, and T5 compared to T1. Conclusion:PEEP of 10 cmH 2 O was effective for providing oxygenation while preserving hemodynamic stability, ICP, and CPP in this model.

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Effects of positive end-expiratory pressure on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation*

Cited by 165 publications

References 20 publications

Use of High Frequency Oscillatory Ventilation (HFOV) in Neurocritical Care Patients

Use of High Frequency Oscillatory Ventilation (HFOV) in Neurocritical Care Patients

Effects of high positive end‐expiratory pressure on haemodynamics and cerebral oxygenation during pneumoperitoneum in the Trendelenburg position

Effects of positive end-expiratory pressure on intracranial pressure during pneumoperitoneum and Trendelenburg position in a porcine model*

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