Positive End-Expiratory Pressure Alters Intracranial and Cerebral Perfusion Pressure in Severe Traumatic Brain Injury

Huynh, Toan; Messer, Marcia; Sing, Ronald F.; Miles, W. F. A.; Jacobs, David; Thomason, Michael

doi:10.1097/00005373-200209000-00016

Cited by 112 publications

(53 citation statements)

References 24 publications

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“…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: 54%

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: Discussioncontrasting

confidence: 54%

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

et al. 2007

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“…Concerns about the worsening of ICP with PEEP have not been confirmed [127,128]. In any case, it must be titrated at the lowest possible level.…”

Section: Initial Neurologic Evaluation Of the Trauma Patientmentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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“…Low levels of PEEP to improve alveolar recruitment have been shown to not change ICP (Mascia et al 2005). Increasing PEEP to as high as 15 cmH2O to improve oxygenation was paradoxically associated with decreases in ICP and improved CPP (Huynh et al 2002).…”

Section: Respiratory Supportmentioning

confidence: 99%

Neuro Critical Care

Majumdar¹

2012

Explicative Cases of Controversial Issues in Neurosurgery

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Positive End-Expiratory Pressure Alters Intracranial and Cerebral Perfusion Pressure in Severe Traumatic Brain Injury

Abstract: In trauma patients with severe TBI, the strategy of increasing PEEP to optimize oxygenation is not associated with reduced cerebral perfusion or compromised oxygen transport.

Cited by 112 publications

References 24 publications

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

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

Critical Care Issues in the Early Management of Severe Trauma

Neuro Critical Care

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