Impact of positive end-expiratory pressure on cerebral injury patients with hypoxemia

Zhang, Xiangyu; Yang, Zhen; Wang, Qi-xing; Huang, Fan

doi:10.1016/j.ajem.2010.01.042

Cited by 41 publications

(28 citation statements)

References 14 publications

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“…Anemia (hemoglobin < 9 g/dl) is associated with lower PbtO 2 after TBI [91] and SAH [92,93] and PbtO 2 monitoring may help guide transfusion endpoints [91,[94][95][96][97]. The variable effects of sedation, anesthetic agents, and ''wake-up tests'' on individual patients can be examined using PbtO 2 data [98][99][100][101][102][103][104][105]. PbtO 2 levels may help guide ventilator management [106].…”

Section: Does Pbto 2 Monitoring Help Guide Management?mentioning

confidence: 99%

“…Ten studies, including two small RCTs, addressed how systemic oxygen monitoring can guide neurocritical care management. In summary, pulse oximetry or ABG analysis can reliably detect pulmonary and circulatory abnormalities [271], and guide correction of brain oxygen in select patients when using normobaric hyperoxia [147,272], PEEP [105,107,108,273], recruitment maneuvers [274,275], or prone positioning [276].…”

Section: Can Systemic Oxygen Monitoring Help Guide Management?mentioning

confidence: 99%

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Monitoring of Brain and Systemic Oxygenation in Neurocritical Care Patients

Oddo

Bösel

2014

Neurocrit Care

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Maintenance of adequate oxygenation is a mainstay of intensive care, however, recommendations on the safety, accuracy, and the potential clinical utility of invasive and non-invasive tools to monitor brain and systemic oxygenation in neurocritical care are lacking. A literature search was conducted for English language articles describing bedside brain and systemic oxygen monitoring in neurocritical care patients from 1980 to August 2013. Imaging techniques e.g., PET are not considered. A total of 281 studies were included, the majority described patients with traumatic brain injury (TBI). All tools for oxygen monitoring are safe. Parenchymal brain oxygen (PbtO2) monitoring is accurate to detect brain hypoxia, and it is recommended to titrate individual targets of cerebral perfusion pressure (CPP), ventilator parameters (PaCO2, PaO2), and transfusion, and to manage intracranial hypertension, in combination with ICP monitoring. SjvO2 is less accurate than PbtO2. Given limited data, NIRS is not recommended at present for adult patients who require neurocritical care. Systemic monitoring of oxygen (PaO2, SaO2, SpO2) and CO2 (PaCO2, end-tidal CO2) is recommended in patients who require neurocritical care.

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Section: Does Pbto 2 Monitoring Help Guide Management?mentioning

confidence: 99%

Section: Can Systemic Oxygen Monitoring Help Guide Management?mentioning

confidence: 99%

Monitoring of Brain and Systemic Oxygenation in Neurocritical Care Patients

Oddo

Bösel

2014

Neurocrit Care

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“…High PEEP levels may decrease cerebral venous outflow, cardiac output, and mean arterial pressure resulting in decreased cerebral perfusion pressure (CPP). In patients with acute brain injury and impaired cerebral autoregulation, PEEP did not change ICP, cerebral perfusion, or oxygenation if adequate blood pressure was maintained [50-52]. PEEP should not increase ICP if ICP exceeds right atrial pressure [53].…”

Section: Brain-oriented Intensive Care Managementmentioning

confidence: 99%

Brain Resuscitation in the Drowning Victim

et al. 2012

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Drowning is a leading cause of accidental death. Survivors may sustain severe neurologic morbidity. There is negligible research specific to brain injury in drowning making current clinical management non-specific to this disorder. This review represents an evidence-based consensus effort to provide recommendations for management and investigation of the drowning victim. Epidemiology, brain-oriented prehospital and intensive care, therapeutic hypothermia, neuroimaging/monitoring, biomarkers, and neuroresuscitative pharmacology are addressed. When cardiac arrest is present, chest compressions with rescue breathing are recommended due to the asphyxial insult. In the comatose patient with restoration of spontaneous circulation, hypoxemia and hyperoxemia should be avoided, hyperthermia treated, and induced hypothermia (32–34 °C) considered. Arterial hypotension/hypertension should be recognized and treated. Prevent hypoglycemia and treat hyperglycemia. Treat clinical seizures and consider treating non-convulsive status epilepticus. Serial neurologic examinations should be provided. Brain imaging and serial biomarker measurement may aid prognostication. Continuous electroencephalography and N20 somatosensory evoked potential monitoring may be considered. Serial biomarker measurement (e.g., neuron specific enolase) may aid prognostication. There is insufficient evidence to recommend use of any specific brain-oriented neuroresuscitative pharmacologic therapy other than that required to restore and maintain normal physiology. Following initial stabilization, victims should be transferred to centers with expertise in age-specific post-resuscitation neurocritical care. Care should be documented, reviewed, and quality improvement assessment performed. Preclinical research should focus on models of asphyxial cardiac arrest. Clinical research should focus on improved cardiopulmonary resuscitation, re-oxygenation/reperfusion strategies, therapeutic hypothermia, neuroprotection, neurorehabilitation, and consideration of drowning in advances made in treatment of other central nervous system disorders.

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“…In the literature, several ventilation strategies including volume control ventilation, pressure control ventilation, recruitment maneuvers, and PEEP application are discussed for the management of ventilation and oxygenation problems caused by increased intraabdominal pressure and head-down position (19)(20)(21)(22)(23). The importance of PEEP application for maintaining adequate gas exchange while preventing ventilator-induced lung injury is especially emphasized (7,10,22,23).…”

Section: Discussionmentioning

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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Impact of positive end-expiratory pressure on cerebral injury patients with hypoxemia

Cited by 41 publications

References 14 publications

Monitoring of Brain and Systemic Oxygenation in Neurocritical Care Patients

Monitoring of Brain and Systemic Oxygenation in Neurocritical Care Patients

Brain Resuscitation in the Drowning Victim

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

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