This study explored the impact of positive end expiratory pressure (PEEP) on intracranial pressure (ICP), cerebral perfusion pressure (CPP), central venous pressure (CVP) and mean arterial pressure (MAP) in cerebral injury patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS).
Nine cerebral injury patients with lung injury who needed mechanical ventilation and met criteria for ICP monitoring were included in this clinical trial from May 2007 to March 2008. Intra-ventricular catheters were positioned in one of the bilateral ventricles and connected to pressure transducers. Invasive arterial pressure and CVP were monitored continuously. Pressure control ventilation was applied during this clinical trial in stepwise recruitment maneuver (RM) with intermittent incremental and decrement PEEP of 3 cmH2O.
Total 28 RMs were completed in 9 patients. Mean values of MAP, CVP, ICP and CPP five minutes following RMs showed no significant differences compared with baseline (p > 0.05). Correlation analysis of all the mean values of MAP, CVP, ICP and CPP showed significant correlation between MAP and CPP, PEEP and CVP, PEEP and ICP, PEEP and CPP, all p values were less than 0.05. A positive correlation between MAP and CPP existed in 89.3% (25/28)of total RMs. A positive correlation between PEEP and CVP existed in 85.7% (24/28) of total RMs. A positive correlation between PEEP and ICP existed in 75.0% (21/28) of total RMs. A negative correlation between PEEP and CPP existed in 60.7% (17/28) of total RMs.
The impact of PEEP on blood pressure, ICP and CPP are of great variation in cerebral injury patients. MAP and ICP monitoring will benefit to guide PEEP in cerebral injury patients with hypoxemia.
ICP and invasive MAP need to be monitored when applying RM in cerebral injury patients with ARDS.
Xiangyu Zhang, No Financial Disclosure Information; No Product/Research Disclosure Information