Schedl R, Baum M, Benzer H, Kiss F, Mutz N, Spängler H
Anaesthesist. 1985 Nov;34(11):578-81.
The influence of respiratory frequency, tidal volume, inspiratory flow and ratio of inspiratory/expiratory time on ventilator-related intracranial pressure (ICP) fluctuations was studied in six patients with severe brain trauma. ICP fluctuations were found to be markedly reduced at frequencies of 20/min and usually eliminated at 30/min. We found an exponential correlation between ICP fluctuations and respiratory frequency, but there was no correlation between tidal volume and ICP. Central venous pressure amplitudes were found to be in linear correlation with respiratory frequency and tidal volumes as well. The amplitude of respiratory ICP fluctuations correlates with the length of expiratory time. Our findings demonstrate that artificial ventilation without ventilator-related fluctuations in ICP ("brain-protective" ventilation) may be performed by conventional volume-constant, time-cycled ventilators. To assess the therapeutic relevance of eliminating respirator-related fluctuations of the ICP course in brain-injured patients, we suggest that frequencies of 25-30/min and tidal volumes of 6-9 ml/kg body weight should be used.
在6例重型颅脑损伤患者中，研究了呼吸频率、潮气量、吸气流量和吸呼时间比与呼吸机相关性颅内压（ICP）波动的关系。发现呼吸频率为20次/分钟时ICP波动明显减小，30次/分钟时通常可消除。我们发现ICP波动与呼吸频率呈指数相关，但潮气量与ICP之间无相关性。中心静脉压幅度也与呼吸频率和潮气量呈线性相关。呼吸性ICP波动幅度与呼气时间长度相关。我们的研究结果表明，传统的容量恒定、时间切换呼吸机可实现无呼吸机相关性ICP波动的人工通气（“脑保护”通气）。为评估消除脑损伤患者呼吸相关性ICP波动的治疗意义，我们建议使用25 - 30次/分钟的频率和6 - 9毫升/千克体重的潮气量。
