Intensive Medicine Department, UCI de Trauma y Emergencias, UCITE, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain.
Intensive Medicine Department, UCI de Trauma y Emergencias, UCITE, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain.
Med Intensiva (Engl Ed). 2024 Oct;48(10):594-601. doi: 10.1016/j.medine.2024.04.017. Epub 2024 May 29.
To analyze the impact of positive end-expiratory pressure (PEEP) changes on intracranial pressure (ICP) dynamics in patients with acute brain injury (ABI).
Observational, prospective and multicenter study (PEEP-PIC study).
Seventeen intensive care units in Spain.
Neurocritically ill patients who underwent invasive neuromonitorization from November 2017 to June 2018.
Baseline ventilatory, hemodynamic and neuromonitoring variables were collected immediately before PEEP changes and during the following 30 min.
PEEP and ICP changes.
One-hundred and nine patients were included. Mean age was 52.68 (15.34) years, male 71 (65.13%). Traumatic brain injury was the cause of ABI in 54 (49.54%) patients. Length of mechanical ventilation was 16.52 (9.23) days. In-hospital mortality was 21.1%. PEEP increases (mean 6.24-9.10 cmH2O) resulted in ICP increase from 10.4 to 11.39 mmHg, P < .001, without changes in cerebral perfusion pressure (CPP) (P = .548). PEEP decreases (mean 8.96 to 6.53 cmH2O) resulted in ICP decrease from 10.5 to 9.62 mmHg (P = .052), without changes in CPP (P = .762). Significant correlations were established between the increase of ICP and the delta PEEP (R = 0.28, P < .001), delta driving pressure (R = 0.15, P = .038) and delta compliance (R = -0.14, P = .052). ICP increment was higher in patients with lower baseline ICP.
PEEP changes were not associated with clinically relevant modifications in ICP values in ABI patients. The magnitude of the change in ICP after PEEP increase was correlated with the delta of PEEP, the delta driving pressure and the delta compliance.
分析急性脑损伤（ABI）患者中呼气末正压（PEEP）变化对颅内压（ICP）动态的影响。
观察性、前瞻性和多中心研究（PEEP-PIC 研究）。
西班牙 17 个重症监护病房。
2017 年 11 月至 2018 年 6 月接受有创神经监测的神经危重症患者。
在 PEEP 变化前后立即收集基线通气、血流动力学和神经监测变量，并在接下来的 30 分钟内进行监测。
PEEP 和 ICP 变化。
共纳入 109 例患者，平均年龄 52.68（15.34）岁，男性 71 例（65.13%）。54 例（49.54%）患者因创伤性脑损伤导致 ABI。机械通气时间为 16.52（9.23）天。院内死亡率为 21.1%。PEEP 增加（平均 6.24-9.10 cmH2O）导致 ICP 从 10.4 增加至 11.39 mmHg，P<.001，而脑灌注压（CPP）无变化（P=.548）。PEEP 降低（平均 8.96 至 6.53 cmH2O）导致 ICP 从 10.5 降至 9.62 mmHg（P=.052），CPP 无变化（P=.762）。ICP 升高与 PEEP 差值（R=0.28，P<.001）、驱动压差值（R=0.15，P=.038）和顺应性差值（R=-0.14，P=.052）呈显著相关。ICP 基线较低的患者 ICP 升高幅度更大。
PEEP 变化与 ABI 患者 ICP 值无临床相关变化相关。PEEP 增加后 ICP 变化幅度与 PEEP、驱动压和顺应性的差值相关。
