Traumatic Brain Injury Clinical Trial
Official title:
Doctor of Department of Emergency and Critical Care Medicine, Zhoupu Hospital Affiliated With Shanghai University of Medicine and Health Sciences, Shanghai 201318, PR China
The impact of PEEP on ICP was dependent on the difference between elevated CVP levels and baseline ICP levels. ICP would increase once elevated CVP through PEEP adjustment exceeds the baseline ICP.
all patients were exposed to incremental PEEP levels of 0, 5, 10, and 15cmH2O with 100% of
FiO2. The measurements were done bedside on stabilized hemodynamics and intracranial
pressure. The measurement was discontinued if the following situation presented and remedies
were applied accordingly: (1) CPP < 60 mmHg (norepinephrine at 0.3~1.0μg/kg.min was used);
(2) ICP > 25 mmHg (PEEP was restored to 0); (3) increase of pressure plateau > 35 cmH2O
(tidal volume was decreased and PetCO2 was maintained at 30~35mmHg); (4) SpO2 < 90% (PEEP was
restored to 0); and (5) suspicion of pneumothorax (PEEP was restored to 0 and chest
radiography was performed). An equilibration period (at least 90 seconds) was entailed to
ensure a normalized baseline PetCO2 through modulating tidal volume and respiratory rate.
ICP, CVP, Pj, and MAP were measured twice or more at each level of PEEP for consecutively
five days after admission. CPP was calculated according to the following equation:
CPP=MAP-ICP. The difference between baseline ICP and CVP was categorized into the following
three groups according to the previous findings: Group I,IVPD ≤ 3mmHg, Group II, 3 < IVPD ≤ 6
mmHg, Group III, IVPD > 6 mmHg. Relationships between PEEP and ICP, CVP and MAP, CVP and Pj
were analyzed in each group respectively.
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