Translational Medicine, The Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
Departments of Critical Care Medicine and Anesthesiology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Crit Care Med. 2019 Feb;47(2):254-263. doi: 10.1097/CCM.0000000000003558.
A narrative review of the pathophysiology linking altered airway pressure and intracranial pressure and cerebral oxygenation.
Online search of PubMed and manual review of articles (laboratory and patient studies) of the altered airway pressure on intracranial pressure, cerebral perfusion, or cerebral oxygenation.
Randomized trials, observational and physiologic studies.
Our group determined by consensus which resources would best inform this review.
In the normal brain, positive-pressure ventilation does not significantly alter intracranial pressure, cerebral oxygenation, or perfusion. In injured brains, the impact of airway pressure on intracranial pressure is variable and determined by several factors; a cerebral venous Starling resistor explains much of the variability. Negative-pressure ventilation can improve cerebral perfusion and oxygenation and reduce intracranial pressure in experimental models, but data are limited, and mechanisms and clinical benefit remain uncertain.
The effects of airway pressure and ventilation on cerebral perfusion and oxygenation are increasingly understood, especially in the setting of brain injury. In the face of competing mechanisms and priorities, multimodal monitoring and individualized titration will increasingly be required to optimize care.
对气道压力改变与颅内压和脑氧合之间的病理生理学进行叙述性综述。
在线搜索 PubMed 以及对气道压力改变对颅内压、脑灌注或脑氧合的影响的（实验室和患者）研究的文章进行手工综述。
随机试验、观察性和生理学研究。
我们的小组通过共识确定了哪些资源最能为本次综述提供信息。
在正常大脑中，正压通气不会显著改变颅内压、脑氧合或灌注。在受损的大脑中，气道压力对颅内压的影响是可变的，由几个因素决定；一个脑静脉 Starling 电阻器解释了大部分的可变性。负压通气可以改善脑灌注和氧合，并降低实验模型中的颅内压，但数据有限，其机制和临床获益仍不确定。
气道压力和通气对脑灌注和氧合的影响越来越被理解，尤其是在脑损伤的情况下。面对相互竞争的机制和优先级，需要越来越多地采用多模式监测和个体化滴定来优化治疗。
