Effect of increased positive end-expiratory pressure on intracranial pressure and cerebral oxygenation: impact of respiratory mechanics and hypovolemia

Abstract Background To evaluate the impact of positive end-expiratory pressure (PEEP) on intracranial pressure (ICP) in animals with different respiratory mechanics, baseline ICP and volume status. Methods A total of 50 male adult Bama miniature pigs were involved in four different protocols (n = 20...

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Autores principales:	Han Chen, Xiao-Fen Zhou, Da-Wei Zhou, Jian-Xin Zhou, Rong-Guo Yu
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Positive end-expiratory pressure Intracranial pressure Cerebral oxygenation Cerebral blood flow Respiratory mechanics Hypovolemia Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurophysiology and neuropsychology QP351-495
Acceso en línea:	https://doaj.org/article/002f94e82e14485c813baa1efc1a933d
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spelling	oai:doaj.org-article:002f94e82e14485c813baa1efc1a933d2021-11-28T12:30:39ZEffect of increased positive end-expiratory pressure on intracranial pressure and cerebral oxygenation: impact of respiratory mechanics and hypovolemia10.1186/s12868-021-00674-91471-2202https://doaj.org/article/002f94e82e14485c813baa1efc1a933d2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12868-021-00674-9https://doaj.org/toc/1471-2202Abstract Background To evaluate the impact of positive end-expiratory pressure (PEEP) on intracranial pressure (ICP) in animals with different respiratory mechanics, baseline ICP and volume status. Methods A total of 50 male adult Bama miniature pigs were involved in four different protocols (n = 20, 12, 12, and 6, respectively). Under the monitoring of ICP, brain tissue oxygen tension and hemodynamical parameters, PEEP was applied in increments of 5 cm H2O from 5 to 25 cm H2O. Measurements were taken in pigs with normal ICP and normovolemia (Series I), or with intracranial hypertension (via inflating intracranial balloon catheter) and normovolemia (Series II), or with intracranial hypertension and hypovolemia (via exsanguination) (Series III). Pigs randomized to the control group received only hydrochloride instillation while the intervention group received additional chest wall strapping. Common carotid arterial blood flow before and after exsanguination at each PEEP level was measured in pigs with intracranial hypertension and chest wall strapping (Series IV). Results ICP was elevated by increased PEEP in both normal ICP and intracranial hypertension conditions in animals with normal blood volume, while resulted in decreased ICP with PEEP increments in animals with hypovolemia. Increasing PEEP resulted in a decrease in brain tissue oxygen tension in both normovolemic and hypovolemic conditions. The impacts of PEEP on hemodynamical parameters, ICP and brain tissue oxygen tension became more evident with increased chest wall elastance. Compare to normovolemic condition, common carotid arterial blood flow was further lowered when PEEP was raised in the condition of hypovolemia. Conclusions The impacts of PEEP on ICP and cerebral oxygenation are determined by both volume status and respiratory mechanics. Potential conditions that may increase chest wall elastance should also be ruled out to avoid the deleterious effects of PEEP.Han ChenXiao-Fen ZhouDa-Wei ZhouJian-Xin ZhouRong-Guo YuBMCarticlePositive end-expiratory pressureIntracranial pressureCerebral oxygenationCerebral blood flowRespiratory mechanicsHypovolemiaNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurophysiology and neuropsychologyQP351-495ENBMC Neuroscience, Vol 22, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Positive end-expiratory pressure Intracranial pressure Cerebral oxygenation Cerebral blood flow Respiratory mechanics Hypovolemia Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurophysiology and neuropsychology QP351-495
spellingShingle	Positive end-expiratory pressure Intracranial pressure Cerebral oxygenation Cerebral blood flow Respiratory mechanics Hypovolemia Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurophysiology and neuropsychology QP351-495 Han Chen Xiao-Fen Zhou Da-Wei Zhou Jian-Xin Zhou Rong-Guo Yu Effect of increased positive end-expiratory pressure on intracranial pressure and cerebral oxygenation: impact of respiratory mechanics and hypovolemia
description	Abstract Background To evaluate the impact of positive end-expiratory pressure (PEEP) on intracranial pressure (ICP) in animals with different respiratory mechanics, baseline ICP and volume status. Methods A total of 50 male adult Bama miniature pigs were involved in four different protocols (n = 20, 12, 12, and 6, respectively). Under the monitoring of ICP, brain tissue oxygen tension and hemodynamical parameters, PEEP was applied in increments of 5 cm H2O from 5 to 25 cm H2O. Measurements were taken in pigs with normal ICP and normovolemia (Series I), or with intracranial hypertension (via inflating intracranial balloon catheter) and normovolemia (Series II), or with intracranial hypertension and hypovolemia (via exsanguination) (Series III). Pigs randomized to the control group received only hydrochloride instillation while the intervention group received additional chest wall strapping. Common carotid arterial blood flow before and after exsanguination at each PEEP level was measured in pigs with intracranial hypertension and chest wall strapping (Series IV). Results ICP was elevated by increased PEEP in both normal ICP and intracranial hypertension conditions in animals with normal blood volume, while resulted in decreased ICP with PEEP increments in animals with hypovolemia. Increasing PEEP resulted in a decrease in brain tissue oxygen tension in both normovolemic and hypovolemic conditions. The impacts of PEEP on hemodynamical parameters, ICP and brain tissue oxygen tension became more evident with increased chest wall elastance. Compare to normovolemic condition, common carotid arterial blood flow was further lowered when PEEP was raised in the condition of hypovolemia. Conclusions The impacts of PEEP on ICP and cerebral oxygenation are determined by both volume status and respiratory mechanics. Potential conditions that may increase chest wall elastance should also be ruled out to avoid the deleterious effects of PEEP.
format	article
author	Han Chen Xiao-Fen Zhou Da-Wei Zhou Jian-Xin Zhou Rong-Guo Yu
author_facet	Han Chen Xiao-Fen Zhou Da-Wei Zhou Jian-Xin Zhou Rong-Guo Yu
author_sort	Han Chen
title	Effect of increased positive end-expiratory pressure on intracranial pressure and cerebral oxygenation: impact of respiratory mechanics and hypovolemia
title_short	Effect of increased positive end-expiratory pressure on intracranial pressure and cerebral oxygenation: impact of respiratory mechanics and hypovolemia
title_full	Effect of increased positive end-expiratory pressure on intracranial pressure and cerebral oxygenation: impact of respiratory mechanics and hypovolemia
title_fullStr	Effect of increased positive end-expiratory pressure on intracranial pressure and cerebral oxygenation: impact of respiratory mechanics and hypovolemia
title_full_unstemmed	Effect of increased positive end-expiratory pressure on intracranial pressure and cerebral oxygenation: impact of respiratory mechanics and hypovolemia
title_sort	effect of increased positive end-expiratory pressure on intracranial pressure and cerebral oxygenation: impact of respiratory mechanics and hypovolemia
publisher	BMC
publishDate	2021
url	https://doaj.org/article/002f94e82e14485c813baa1efc1a933d
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Effect of increased positive end-expiratory pressure on intracranial pressure and cerebral oxygenation: impact of respiratory mechanics and hypovolemia

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