PEEP 对急性脑损伤患者颅内压的影响：一项前瞻性多中心观察研究

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva Pub Date : 2024-09-26 DOI:10.1016/j.medin.2024.04.011

Jesús Abelardo Barea-Mendoza, Zaira Molina-Collado, María Ángeles Ballesteros-Sanz, Luisa Corral-Ansa, Maite Misis del Campo, Cándido Pardo-Rey, Juan Angel Tihista-Jiménez, Carmen Corcobado-Márquez, Juan Pedro Martín del Rincón, Juan Antonio Llompart-Pou, Luis Alfonso Marcos-Prieto, Ander Olazabal-Martínez, Rubén Herrán-Monge, Ana María Díaz-Lamas, Mario Chico-Fernández

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引用次数: 0

摘要

目的分析呼气末正压（PEEP）变化对急性脑损伤（ABI）患者颅内压（ICP）动态的影响.设计观察性、前瞻性和多中心研究（PEEP-PIC 研究）.设置西班牙的 17 个重症监护病房.患者2017年11月至2018年6月期间接受有创神经监测的神经重症患者.干预措施在PEEP变化前和随后的30分钟内收集基线通气、血流动力学和神经监测变量.主要关注变量PEEP和ICP变化.结果纳入了109名患者。平均年龄为 52.68 (15.34)岁，男性 71 (65.13%)。54例（49.54%）患者的 ABI 起因是脑外伤。机械通气时间为 16.52 (9.23) 天。院内死亡率为 21.1%。PEEP 增加（平均 6.24-9.10 cmH2O）导致 ICP 从 10.4 mmHg 增加到 11.39 mmHg，P < .001，而脑灌注压 (CPP) 无变化（P = .548）。PEEP 降低（平均值从 8.96 cmH2O 降至 6.53 cmH2O）导致 ICP 从 10.5 mmHg 降至 9.62 mmHg（P = .052），而 CPP 无变化（P = .762）。ICP 的增加与 delta PEEP (R = 0.28, P < .001)、delta 驱动压 (R = 0.15, P = .038) 和 delta 顺应性 (R = -0.14, P = .052) 之间存在显著相关性。结论PEEP 的变化与 ABI 患者 ICP 值的临床相关变化无关。增加 PEEP 后 ICP 的变化幅度与 PEEP 的δ值、驱动压力的δ值和顺应性的δ值相关。

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Effects of PEEP on intracranial pressure in patients with acute brain injury: An observational, prospective and multicenter study

Objective

To analyze the impact of positive end-expiratory pressure (PEEP) changes on intracranial pressure (ICP) dynamics in patients with acute brain injury (ABI).

Design

Observational, prospective and multicenter study (PEEP-PIC study).

Setting

Seventeen intensive care units in Spain.

Patients

Neurocritically ill patients who underwent invasive neuromonitorization from November 2017 to June 2018.

Interventions

Baseline ventilatory, hemodynamic and neuromonitoring variables were collected immediately before PEEP changes and during the following 30 min.

Main variables of interest

PEEP and ICP changes.

Results

One-hundred and nine patients were included. Mean age was 52.68 (15.34) years, male 71 (65.13%). Traumatic brain injury was the cause of ABI in 54 (49.54%) patients. Length of mechanical ventilation was 16.52 (9.23) days. In-hospital mortality was 21.1%. PEEP increases (mean 6.24–9.10 cmH2O) resulted in ICP increase from 10.4 to 11.39 mmHg, P < .001, without changes in cerebral perfusion pressure (CPP) (P = .548). PEEP decreases (mean 8.96 to 6.53 cmH2O) resulted in ICP decrease from 10.5 to 9.62 mmHg (P = .052), without changes in CPP (P = .762). Significant correlations were established between the increase of ICP and the delta PEEP (R = 0.28, P < .001), delta driving pressure (R = 0.15, P = .038) and delta compliance (R = −0.14, P = .052). ICP increment was higher in patients with lower baseline ICP.

Conclusions

PEEP changes were not associated with clinically relevant modifications in ICP values in ABI patients. The magnitude of the change in ICP after PEEP increase was correlated with the delta of PEEP, the delta driving pressure and the delta compliance.

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来源期刊

Medicina Intensiva CRITICAL CARE MEDICINE-

CiteScore

2.70

自引率

20.00%

发文量

146

审稿时长

33 days

期刊介绍： Medicina Intensiva is the journal of the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC) and of Pan American and Iberian Federation of Societies of Intensive and Critical Care Medicine. Medicina Intensiva has become the reference publication in Spanish in its field. The journal mainly publishes Original Articles, Reviews, Clinical Notes, Consensus Documents, Images, and other information relevant to the specialty. All works go through a rigorous selection process. The journal accepts submissions of articles in English and in Spanish languages. The journal follows the publication requirements of the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE).