Effect of Positive End-Expiratory Pressure on Subdural Intracranial Pressure in Patients Undergoing Supratentorial Craniotomy
Adult respiratory distress syndrome develops in up to 20% of patients with severe head injury. Positive end-expiratory pressure (PEEP) is often required to support oxygenation. It is well known that PEEP might increase ICP in intensive care patients through decreased cerebral venous outflow as well as an effect on venous return and subsequent reduced mean arterial blood pressure. The effect of PEEP on ICP have been the focus of several experimental and clinical studies, and the results and their interpretation remain controversial. All studies were performed at intensive care units in trauma patients and patients with subarachnoid haemorrhage, but the effect of PEEP, however, have not been investigated during craniotomy. In this chapter the effects of 5 and 10 cmH2O PEEP on subdural ICP, cerebral perfusion pressure and jugular bulb pressure were studied during craniotomy for cerebral tumours or cerebral aneurysms.
KeywordsCerebral Perfusion Pressure Cerebral Aneurysm Adult Respiratory Distress Syndrome Cerebral Tumour Respiratory System Compliance
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Caricato A, Conti G, Della Corte F et al (2005) Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: the role of respiratory system compliance. J Trauma 58:571–576PubMedGoogle Scholar
Doblar DD, Santiago TV, Kahn AU (1981) The effect of positive end-expiratory pressure ventilation (PEEP) on cerebral blood flow and cerebrospinal fluid pressure in goats. Anesthesiology. 55:244–250PubMedCrossRefGoogle Scholar
Frost EA (1977) Effects of positive end-expiratory pressure on intracranial pressure and compliance in brain-injured patients. J Neurosurg 47:195–200PubMedGoogle Scholar
Georgiadis MD, Schwarz S, Baumgartner RW et al (2001) Influence of positive end-expiratory pressure on intracranial pressure and cerebral perfusion pressure in patients with acute stroke. Stroke 32:2088–2092PubMedCrossRefGoogle Scholar
Hedenstierna G, Rothen HU (2000) Atelectasis formation during anesthesia: causes and measures to prevent it. J Clin Monit Comput 16:329–335PubMedCrossRefGoogle Scholar
Mascia L, Grasso S, Fiore T et al (2005) Cerebro-pulmonary interactions during the application of low levels of positive end-expiratory pressure. Intensive Care Med 31:373–379PubMedCrossRefGoogle Scholar
McGuire G, Crossley D, Richards J (1997) Effects of varying levels of positive end-expiratory pressure on intracranial pressure and cerebral perfusion pressure. Crit Care Med 25:1059–1062PubMedCrossRefGoogle Scholar
Shapiro HM, Marshall LF (1978) Intracranial pressure responses to PEEP in head-injured patients. J Trauma 18:254–256PubMedCrossRefGoogle Scholar
Videtta W, Willarejo F, Cohen M et al (2002) Effects of positive end-expiratory pressure on intracranial pressure and cerebral perfusion pressure. Acta Neurochir Suppl 81:93–97PubMedGoogle Scholar
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