Acute Brain Injuries Clinical Trial
There are concerns that the use of positive end-expiratory pressure (PEEP) for the treatment
of pulmonary complications in patients with brain injury may potentially elevate
intracranial pressure (ICP), and deteriorate neurological status. It is suggested that both
respiratory system compliance and ventricular compliance would contribute to the elevation
of ICP when PEEP increases. In theory, PEEP may cause elevation of ICP by increasing
intrathoracic pressure and diminish venous return. However, the transmission of PEEP into
thoracic cavity depends on the properties of the lung and chest wall. Experimental study
showed that when chest wall compliance is low, PEEP can significantly increases
intrathoracic pressure; whereas low lung compliance can minimize airway pressure
transmission. It is generally recognized that the lung compliance decreases in acute
respiratory distress syndrome (ARDS) patients due to extensive alveolar collapse. However,
it has been report that the elastance ratio (the ratio between elastance of the chest wall
and the respiratory system, where elastance is the reciprocal of compliance) may vary from
0.2 to 0.8. Therefore, it is important to distinguish the compliance of the chest wall and
the lung when investigating the effect of PEEP on ICP.
Because intrathoracic pressure (pleural pressure) is difficult to measure in clinical
situations, esophageal pressure (Pes) is considered as a surrogate of intrathoracic
pressure. In the present study, the investigators determine the effect of PEEP on
intrathoracic pressure and ICP by Pes measurement.
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