The Influence of Airway Pressure Changes on Intracranial Pressure (ICP) and the Blood Flow Velocity in the Middle Cerebral Artery (VMCA)

Ludwig, Hans; Klingler, Marco; Timmermann, Albert; Weyland, W.; Mursch, Kay; Reparon, C; Markakis, E.

doi:10.1055/s-2000-13008

Cited by 19 publications

(7 citation statements)

References 11 publications

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“…RM leads to a decrease in rSO 2 and V-MCA, which may be related to intracranial pressure (ICP) and CPP. Changes in rSO 2 and V-MCA were associated with the changes in ICP and CPP [ 34 , 35 ]. The change in rSO 2 is negatively correlated with the change in ICP and positively correlated with the change in CPP [ 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Alveolar Recruitment Maneuver Reduces Cerebral Oxygen Saturation and Cerebral Blood Flow Velocity in Patients During Carotid Endarterectomy

Zhao

Wang

et al. 2021

Med Sci Monit

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Background This study aimed to determine the effects of alveolar recruitment maneuver (RM) on cerebral oxygen saturation and cerebral blood velocity in patients undergoing carotid endarterectomy (CEA) before clamping of the carotid artery. Material/Methods In this crossover exploratory study, all patients were randomized to undergo an RM (30 cmH 2 O of continuous airway pressure for 30 s) and a “sham” maneuver (SM; 5 cmH 2 O for 30 s), followed by an alternative intervention after a 5-min equilibration period. Near-infrared spectroscopy (NIRS) was used to monitor regional cerebral oxygen saturation (rSO 2 ), and transcranial Doppler ultrasonography (TCD) to evaluate blood velocity of the middle cerebral artery (V-MCA). Changes in rSO 2 , V-MCA, mean arterial pressure (MAP), and heart rate (HR) in response to the 2 interventions were compared. Results A total of 59 patients underwent the study procedure. RM reduced rSO 2, V-MCA, MAP, and HR, but these variables slightly changed during SM. A significant drop in rSO 2 was observed immediately after RM compared with the baseline value (68.51±4.4% vs 64.12±5.15%; P <0.001). The decrease in rSO 2 was higher during the RM than during the SM (−6±4% vs 1±2%; P <0.001). Similarly, change in V-MCA was more significant in response to RM than SM (−26±19% vs 19±16%; P <0.001). The V-MCA value changed from 39 cm/s to 29 cm/s after RM. In addition, V-MCA of the ipsilateral to the surgical side decreased more obviously than the contralateral side (−26±19% vs −20±17%; P =0.001). Conclusions An RM at 30 cmH 2 O of continuous airway pressure for 30 s decreased rSO 2 and V-MCA. In addition, MAP and HR were affected.

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Section: Discussionmentioning

confidence: 99%

Alveolar Recruitment Maneuver Reduces Cerebral Oxygen Saturation and Cerebral Blood Flow Velocity in Patients During Carotid Endarterectomy

Zhao

Wang

et al. 2021

Med Sci Monit

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“…Pneumothorax with its associated increases in peak airway pressures can indirectly increase the ICP, which will be associated with deleterious outcomes in patients undergoing neurosurgery. [10] The mechanisms of pneumothorax following tracheal intubation are high positive pressure during mechanical ventilation, and the mechanism is primarily the dissection of air along the perivascular sheath of the pulmonary artery presumably due to rupture of perivascular alveoli. [11] In a retrospective study of 19 patients treated for iatrogenic tracheobronchial lesions, 11 (58%) had a single lumen tube, 4 (21%) had a double lumen tube and 2 (10%) by tracheal cannula, the post-operative mortality was 42%, which was not dependent on the rupture but basically by the underlying disease requiring intubation.…”

Section: Discussionmentioning

confidence: 99%

“…Lung ultrasound or a CXR is an easy and quick on table method to diagnose pneumothorax. [10] It should also be stressed that in bougie-guided intubations, the bougie should be stabilised while the endotracheal tube is advanced to avoid tracheobronchial injury.…”

Section: Discussionmentioning

confidence: 99%

A case of pneumothorax following bougie-guided intubation in a patient undergoing excision of an intraventricular space occupying lesion

Rajagopal

Jayaseelan

George

2017

Journal of Neuroanaesthesiology and Critical Care

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A 46-year-old female with intraventricular space occupying lesion was posted for craniotomy and excision of the same. Immediately following routine induction of general anaesthesia and a bougie-guided intubation, she developed increased airway pressures and desaturation associated with a decreased air entry on the right side of the chest suggestive of a right-sided pneumothorax which was confirmed with radio imaging and following the placement of chest drain the saturation improved and airway pressures decreased. To be faced with a pneumothorax following an intubation could be surprising for a non-suspecting anaesthesiologist and it can have important implications especially in neurosurgical cases where a tight control of intracranial pressure is warranted. Hence, this case report emphasises the need for a high index of clinical suspicion for proper management and safe patient outcome.

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“…Additionally, in patients with traumatic brain injury, the application of positive end-expiratory pressure (PEEP) resulted in elevations of CVP, ICP and reductions of cerebral perfusion pressure, blood flow in the middle cerebral artery and cerebral desaturation [ 14 – 17 ]. The detrimental effects of PEEP were more pronounced in patients with normal respiratory system compliance, lower CVP, reduced intracranial compliance and low ICP, all of which favor the transduction of intrapulmonary to intravascular and intracranial pressure.…”

Section: Discussionmentioning

confidence: 99%

Is venous congestion associated with reduced cerebral oxygenation and worse neurological outcome after cardiac arrest?

et al. 2016

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BackgroundPost-cardiac arrest (CA) patients are at risk of secondary ischemic damage in the case of suboptimal brain oxygenation during an ICU stay. We hypothesized that elevated central venous pressures (CVP) would impair cerebral perfusion and oxygenation (venous cerebral congestion). The aim of the present study was to investigate the relationship between CVP, cerebral tissue oxygen saturation (SctO2) as assessed with near-infrared spectroscopy (NIRS) and outcome in post-CA patients.MethodsThis was an observational study in 48 post-CA patients with continuous CVP and SctO2 monitoring during therapeutic hypothermia.ResultsThe relationship between CVP and mean SctO2 was best described by an S-shaped, third-degree polynomial regression curve (SctO2 = −0.002 × CVP3 + 0.08 × CVP2 – 1.07 × CVP + 69.78 %, R2 0.89, n = 1,949,108 data points) with high CVP (>20 mmHg) being associated with cerebral desaturation. Multivariate linear regression revealed CVP to be a more important determinant of SctO2 than mean arterial pressure (MAP) without important interaction between both (SctO2 = 0.01 × MAP – 0.20 × CVP + 0.001 × MAP × CVP + 65.55 %). CVP and cardiac output were independent determinants of SctO2 with some interaction between both (SctO2 = 1.86 × CO – 0.09 × CVP – 0.05 × CO × CVP + 60.04 %). Logistic regression revealed that a higher percentage of time with CVP above 5 mmHg was associated with lower chance of survival with a good neurological outcome (cerebral performance category (CPC) 1–2) at 180 days (OR 0.96, 95 % CI 0.92–1.00, p = 0.04). In a multivariate model, the negative association between CVP and outcome persisted after correction for hemodynamic variables, including ejection fraction and MAP.ConclusionsElevated CVP results in lower brain saturation and is associated with worse outcome in post-CA patients. This pilot study provides support that venous cerebral congestion as indicated by high CVP may be detrimental for post-CA patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1297-2) contains supplementary material, which is available to authorized users.

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The Influence of Airway Pressure Changes on Intracranial Pressure (ICP) and the Blood Flow Velocity in the Middle Cerebral Artery (VMCA)

Cited by 19 publications

References 11 publications

Alveolar Recruitment Maneuver Reduces Cerebral Oxygen Saturation and Cerebral Blood Flow Velocity in Patients During Carotid Endarterectomy

Alveolar Recruitment Maneuver Reduces Cerebral Oxygen Saturation and Cerebral Blood Flow Velocity in Patients During Carotid Endarterectomy

A case of pneumothorax following bougie-guided intubation in a patient undergoing excision of an intraventricular space occupying lesion

Is venous congestion associated with reduced cerebral oxygenation and worse neurological outcome after cardiac arrest?

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