Álmos Schranc, John Daniels, Roberta Südy, Fabienne Fontao, Philippe Bijlenga, Guillaume Plourde, Hervé Quintard
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Intracranial pressure and oxygenation, as well as systemic hemodynamics and gas exchange parameters, were continuously monitored. Data were collected at baseline and at varying PEEP levels for both PCV-VG and FCV ventilation modalities. Following this, FCV ventilation and NEEP levels of -3, -6 and -9 cmH<sub>2</sub>O were applied.</p><p><strong>Results: </strong>ICP remained stable with low PEEP levels, but significantly decreased with NEEP. Lower ICP following NEEP improved cerebral perfusion pressure and cerebral tissue oxygenation (p < 0.05 for all). FCV with NEEP at EEP-6 and EEP-9 significantly improved cardiac output and mean arterial pressure (MAP), compared to PCV-VG and FCV using PEEP (p < 0.05, respectively). There were no significant differences in gas exchange parameters between modalities (PCV-VG vs FCV), and between the application of PEEP or NEEP. No significant correlations were observed between ΔICP and ΔMAP.</p><p><strong>Conclusion: </strong>The application of FCV with NEEP appears to be a safe ventilation mode and offers an additional tool for controlling severe intracranial pressure episodes. 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Although lung-protective ventilation is recommended, the application of increased positive end-expiratory pressure (PEEP) has been associated with elevated intracranial pressure (ICP) due to altered cerebral venous return. This study investigates the effects of flow-controlled ventilation (FCV) using negative end-expiratory pressures (NEEP), on cerebral hemodynamics in a swine model of intracranial hypertension.</p><p><strong>Methods: </strong>A model of intracranial hypertension involving bilateral trepan bolt holes was performed in 14 pigs. Pressure-controlled volume-guaranteed ventilation (PCV-VG) with PEEP and FCV using PEEP and then NEEP were applied. Intracranial pressure and oxygenation, as well as systemic hemodynamics and gas exchange parameters, were continuously monitored. Data were collected at baseline and at varying PEEP levels for both PCV-VG and FCV ventilation modalities. 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引用次数: 0
摘要
背景：脑损伤患者通常需要机械通气。尽管推荐使用肺保护通气，但由于脑静脉回流改变，增加呼气末正压（PEEP）与颅内压（ICP）升高有关。本研究调查了使用呼气末负压（NEEP）的流量控制通气（FCV）对颅内高压猪模型脑血流动力学的影响：方法：对 14 头猪进行了颅内高压模型试验，其中包括双侧穿刺孔。方法：对 14 头猪进行了涉及双侧穿刺孔的颅内高压模型试验，试验中使用了带 PEEP 的压力控制容量保证通气（PCV-VG）和先使用 PEEP 后使用 NEEP 的 FCV。对颅内压和氧饱和度以及全身血液动力学和气体交换参数进行了连续监测。在 PCV-VG 和 FCV 通气模式的基线和不同 PEEP 水平下收集数据。随后，FCV 通气和 NEEP 水平分别为 -3、-6 和 -9 cmH2O：结果：低 PEEP 水平下 ICP 保持稳定，但 NEEP 水平下 ICP 显著下降。结果：低 PEEP 水平下 ICP 保持稳定，而 NEEP 则明显降低。NEEP 后 ICP 降低，改善了脑灌注压和脑组织氧合（P应用 FCV 配合 NEEP 似乎是一种安全的通气模式，并为控制严重颅内压发作提供了额外的工具。这些发现值得在今后的研究中加以验证，并有可能在临床实践中得到重要应用。
Safety of flow-controlled ventilation with positive and negative end-expiratory pressure in a swine model of intracranial hypertension.
Background: Patients with brain damage often require mechanical ventilation. Although lung-protective ventilation is recommended, the application of increased positive end-expiratory pressure (PEEP) has been associated with elevated intracranial pressure (ICP) due to altered cerebral venous return. This study investigates the effects of flow-controlled ventilation (FCV) using negative end-expiratory pressures (NEEP), on cerebral hemodynamics in a swine model of intracranial hypertension.
Methods: A model of intracranial hypertension involving bilateral trepan bolt holes was performed in 14 pigs. Pressure-controlled volume-guaranteed ventilation (PCV-VG) with PEEP and FCV using PEEP and then NEEP were applied. Intracranial pressure and oxygenation, as well as systemic hemodynamics and gas exchange parameters, were continuously monitored. Data were collected at baseline and at varying PEEP levels for both PCV-VG and FCV ventilation modalities. Following this, FCV ventilation and NEEP levels of -3, -6 and -9 cmH2O were applied.
Results: ICP remained stable with low PEEP levels, but significantly decreased with NEEP. Lower ICP following NEEP improved cerebral perfusion pressure and cerebral tissue oxygenation (p < 0.05 for all). FCV with NEEP at EEP-6 and EEP-9 significantly improved cardiac output and mean arterial pressure (MAP), compared to PCV-VG and FCV using PEEP (p < 0.05, respectively). There were no significant differences in gas exchange parameters between modalities (PCV-VG vs FCV), and between the application of PEEP or NEEP. No significant correlations were observed between ΔICP and ΔMAP.
Conclusion: The application of FCV with NEEP appears to be a safe ventilation mode and offers an additional tool for controlling severe intracranial pressure episodes. These findings warrant validation in future studies and may lead to important potential applications in clinical practice.
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