Effect of positive end expiratory pressure ventilation on intracranial pressure in man

Abstract

The effect of positive end expiratory pressure (PEEP) ventilation on intracranial pressure (ICP) was investigated. In 25 patients with severe head trauma with and without associated pulmonary injury the following parameters were simultaneously monitored under mechanical ventilation with and without PEEP: ICP, arterial blood pressure, central venous pressure, arterial blood gases and cardiac rate. The volume-pressure response (VPR) was evaluated in each patient to assess cerebral elastance. There was a significant increase in ICP with the application of PEEP only in the 12 patients who manifested increased cerebral elastance by VPR. Half of this latter group manifested impairment of cerebral perfusion pressure to levels less than 60 mm Hg. Return to baseline ICP levels was observed with termination of PEEP. No significantly consistent changes in other parameters were noted.