Burchiel K J, Steege T D, Wyler A R
Neurosurgery. 1981 Apr;8(4):443-9. doi: 10.1227/00006123-198104000-00007.
In 16 patients with severe head injury and 2 patients with subarachnoid hemorrhage, positive end-expiratory pressure (PEEP) ventilation was required to maintain adequate oxygenation. The effects of PEEP on intracranial pressure (ICP) were evaluated with respect to the volume-pressure response (VPR), an indicator of intracranial compliance, and the static lung compliance (CL). Based on these parameters: (a) All 11 patients with a normal VPR (less than 2 torr) had no significant change in ICP with PEEP therapy. (b) All 5 patients with abnormal VPR and a normal CL (greater than 30 ml/cm H2O) had significantly increased ICP or decreased cerebral perfusion pressure while on PEEP. (c) Two patients with both an abnormal VPR and a decreased CL had no significant change in their ICP with PEEP. (d) Significant elevations of ICP were also seen in 4 patients with abnormal VPRs concurrent with the rapid reduction or withdrawal of PEEP ventilation. Thus, the VPR is an accurate predictor of the effects of PEEP on the ICP. In addition, however, decreased lung compliance may buffer these effects in patients who have decreased intracranial compliance. We propose that ICP monitoring and intracranial compliance determination are necessary in the management of brain-injured patients requiring PEEP ventilation.
在16例重型颅脑损伤患者和2例蛛网膜下腔出血患者中，需要采用呼气末正压（PEEP）通气来维持充足的氧合。根据颅内顺应性指标容量 - 压力反应（VPR）和静态肺顺应性（CL），评估了PEEP对颅内压（ICP）的影响。基于这些参数：（a）所有11例VPR正常（小于2托）的患者在接受PEEP治疗时ICP无显著变化。（b）所有5例VPR异常且CL正常（大于30 ml/cm H₂O）的患者在使用PEEP时ICP显著升高或脑灌注压降低。（c）2例VPR异常且CL降低的患者在使用PEEP时ICP无显著变化。（d）4例VPR异常且同时快速降低或停用PEEP通气的患者也出现了ICP的显著升高。因此，VPR是PEEP对ICP影响的准确预测指标。然而，此外，肺顺应性降低可能会缓冲颅内顺应性降低患者的这些影响。我们建议，在管理需要PEEP通气的脑损伤患者时，进行ICP监测和颅内顺应性测定是必要的。
