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Effects of positive end-expiratory pressure on intracranial pressure,cerebral perfusion pressure,and brain oxygenation in acute brain injury:Friend or foe?A scoping review

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Journal of Intensive Medicine 2024年第2期4卷 247-260页

作者： Greta Zunino Denise Battaglini Daniel Agustin Godoy IRCCS Ospedale Policlinico San Martino GenovaItaly Dipartimento di Scienze Diagnostiche e Chirurgiche Integrate Universitàdegli Studi di GenovaGenovaItaly Neurointensive Care Unit Sanatorio PasteurCatamarcaArgentina

Background Patients with acute brain injury(ABI)are a peculiar population because ABI does not only affect the brain but also other organs such as the lungs,as theorized in brain–lung crosstalk *** patients often require mechanical ventilation(MV)to avoid the complications of impaired respiratory function that can follow ABI;MV should be settled with meticulousness owing to its effects on the intracranial compartment,especially regarding positive end-expiratory pressure(PEEP).This scoping review aimed to(1)describe the physiological basis and mechanisms related to the effects of PEEP in ABI;(2)examine how clinical research is conducted on this topic;(3)identify methods for setting PEEP in ABI;and(4)investigate the impact of the application of PEEP in ABI on the *** The five-stage paradigm devised by Peters et *** expanded by Arksey and O'Malley,Levac et al.,and the Joanna Briggs Institute was used for *** also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)extension *** criteria:we compiled all scientific data from peer-reviewed journals and studies that discussed the application of PEEP and its impact on intracranial pressure,cerebral perfusion pressure,and brain oxygenation in adult patients with *** criteria:studies that only examined a pediatric patient group(those under the age of 18),experiments conducted solely on animals;studies without intracranial pressure and/or cerebral perfusion pressure determinations,and studies with incomplete *** authors searched and screened for inclusion in papers published up to July 2023 using the PubMed-indexed online *** were presented in narrative and tubular *** The initial search yielded 330 references on the application of PEEP in ABI,of which 36 met our inclusion *** has recognized beneficial effects on gas exchange,but it produces hemodynamic changes that should be predicted to avoi

关键词： Acute brain injury Mechanical ventilation positive end-expiratory pressure Intracranial pressure Brain-lung crosstalk Multimodal monitoring

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positive end-expiratory pressure Titration after Alveolar Flecruitment Directed by Electrical Impedance Tomography

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Chinese Medical Journal 2015年第11期128卷 1421-1427页

作者： Yun Long Da-Wei Liu Huai-Wu He Zhan-Qi Zhao Department of Critical Care Medicine Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100730 China Institute of Technical Medicine Furtwangen University Jakob-Kienzle StraOe 17 D-78054 VS-Schwenningen Germany

Background： Electrical impedance tomography （EIT） is a real-time bedside monitoring tool, which can reflect dynamic regional lung ventilation. The aim of the present study was to monitor regional gas distribution in patients with acute respiratory distress syndrome （ARDS） during positive-end-expiratory pressure （PEEP） titration using EIT. Methods： Eighteen ARDS patients under mechanical ventilation in Department of Critical Care Medicine of Peking Union Medical College Hospital from January to April in 2014 were included in this prospective observational study. After recruitment maneuvers （RMs）, decremental PEEP titration was performed from 20 cmH20 to 5 cmH20 in steps of 3 cmH20 every 5-10 min. Regional over-distension and recruitment were monitored with EIT. Results： After RMs, patient with arterial blood oxygen partial pressure （PaO2）＋ carbon dioxide partial pressure （PaCO2）〉400 mmHg with 100% of fractional inspired oxygen concentration were defined as RM responders. Thirteen ARDS patients was diagnosed as responders whose PaO2 ＋ PaCO2, were higher than nonresponders （419 ± 44 mmHg vs. 170 ±73 mmHg, P 〈 0.0001）. In responders, PEEP mainly increased-recruited pixels in dependent regions and over-distended pixels in nondependent regions. PEEP alleviated global inhomogeneity of tidal volume and end-expiratory lung volume. PEEP levels without significant alveolar derecruitment and over-distension were identified individually. Conclusions： After RMs, PEEP titration significantly affected regional gas distribution in lung, which could be monitored with EIT. EIT has the potential to optimize PEEP titration.

关键词： Acute Respiratory Distress Syndrome Electrical Impedance Tomography positive end-expiratory pressure Recruitment Maneuvers

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Influence of positive end-expiratory pressure upregulation on the right ventricle in critical patients with acute respiratory distress syndrome:an observational cohort study

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Emergency and Critical Care Medicine 2023年第3期3卷 97-103页

作者： Hui Liu Mengjie Song Li Wang Jianguo Xiao Feihu Zhou Department of Critical Care Medicine First Medical CenterChinese PLA General HospitalBeijingChina Ultrasound Department First Medical CenterChinese PLA General HospitalBeijingChina

Background This study aimed to investigate the influence of positive end-expiratory pressure(PEEP)on the right ventricle(RV)of mechanical ventilation-assisted patients through *** Seventy-six patients assisted with mechanical ventilation were enrolled in this *** end-expiratory pressure was upregulated by 4 cm H_(2)O to treat acute respiratory distress syndrome,wherein echocardiography was performed before and after this *** data were also *** variables were compared before and after PEEP *** effect of PEEP was also evaluated in patients with and without decreased static lung compliance(SLC).Results positive end-expiratory pressure upregulation significantly affected the RV *** differences were observed in the following:Tei index(P=0.027),pulmonary artery pressure(P=0.039),tricuspid annular plane systolic excursion(P=0.014),early wave/atrial wave(P=0.002),diaphragm excursion(Ppressure,mean arterial pressure,and base excess(P>0.05).Furthermore,the cardiac output of the RV was not significantly *** patients with decreased SLC(n=41),there were more significant changes in diaphragm excursion(Ppressure(Ppositive end-expiratory pressure upregulation significantly affected the RV function of critically ill patients with acute respiratory distress syndrome,especially in those with decreased SLC.

关键词： Echocardiography positive end-expiratory pressure Right ventricle Static lung compliance Tei index

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Alveolar stability under different combinations of positive end-expiratory pressure and tidal volume： alveolar microscopy in isolated injured rat lungs

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Chinese Medical Journal 2010年第4期123卷 406-411页

作者： LIU Hui Claudius A. Stahl Knut Moeller Matthias Schneider Steven Ganzert ZHAO Zhan-qi TONG Xiao-wen Josef Guttmann Department of Breast Surgery Tongji Hospital Tongji University School of Medicine Shanghai 200065 China Department of Anesthesiology and Critical Care Medicine University Medical Center Freiburg 79106 Germany Biomedical Engineering Furtwangen University VS-Schwenningen 78056 Germany Woman Health Care Center of Tongji University Shanghai 200065 China

Background High positive end-expiratory pressure （PEEP） and low tidal volume （VT） ventilation is thought to be a protective ventilation strategy. It is hypothesized that the stabilization of collapsible alveoli during expiration contributes to lung protection. However, this hypothesis came from analysis of indirect indices like the analysis of the pressure-volume curve of the lung. The purpose of this study was to investigate isolated healthy and injured rat lungs by means of alveolar microscopy, in which combination of PEEP and VT is beneficial with respect to alveolar stability （I-E%）. Methods Alveolar stability was investigated in isolated, non-perfused mechanically ventilated rat lungs. Injured lungs were compared with normal lungs. For both groups three PEEP settings （5, 10, 20 cmH20） were combined with three VT settings （6, 10, 15 ml/kg） resulting in nine PEEP-VT combinations per group. Analysis was performed by alveolar microscopy. Results In normal lungs alveolar stability persisted in all PEEP-VT combinations （I-E% （3.2±11.0）%）. There was no significant difference using different settings （P 〉0.01）. In contrast, alveoli in injured lungs were extremely instable at PEEP levels of 5 cmH20 （mean I-E% 100%） and 10 cmH2O （mean I-E% （30.7±16.8）%）; only at a PEEP of 20 cmH20 were alveoli stabilized （mean I-E% of （0.2±9.3）%）. Conclusions In isolated healthy lungs alveolar stability is almost unaffected by different settings of PEEP and VT. In isolated injured lungs only a high PEEP level of 20 cmH2O resulted in stabilized alveoli whereas lower PEEP levels are associated with alveolar instability.

关键词： alveolar microscopy alveolar mechanics tidal volume positive end-expiratory pressure

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Role of proning and positive end-expiratory pressure in COVID-19

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World Journal of Critical Care Medicine 2021年第5期10卷 183-193页

作者： Kejal D Gandhi Munish Sharma Pahnwat Tonya Taweesedt Salim Surani Department of Medicine Georgetown University/Medstar Washington Hospital CenterWashigtonDC 20010United States Department of Medicine Corpus Christi Medical CenterCorpus ChristiTX 78412United States Department of Medicine Texas A&M UniversityCorpus ChristiTX 78404United States

The novel coronavirus,which was declared a pandemic by the World Health Organization in early 2020 has brought with itself major morbidity and *** has increased hospital occupancy,heralded economic turmoil,and the rapid transmission and community spread have added to the burden of the *** of the patients are admitted to the intensive care unit(ICU)for acute hypoxic respiratory failure often secondary to acute respiratory distress syndrome(ARDS).Based on the limited data available,there have been different opinions about the respiratory mechanics of the ARDS caused by coronavirus disease 2019(COVID-19).Our article provides an insight into COVID-19 pathophysiology and how it differs from typical *** on these differences,our article explains the different approach to ventilation in COVID-19 ARDS compared to typical *** critically analyze the role of positive end-expiratory pressure(PEEP)and proning in the ICU *** the limited data and clinical experience are available,we believe that early proning in COVID-19 patients improves oxygenation and optimal PEEP should be titrated based on individual lung compliance.

关键词： COVID-19 Acute respiratory distress syndrome positive end-expiratory pressure Proning Ventilation management Acute respiratory distress syndrome Intensive care unit

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Driving pressure in mechanical ventilation:A review

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World Journal of Critical Care Medicine 2024年第1期13卷 15-27页

作者： Syeda Farheen Zaidi Asim Shaikh Daniyal Aziz Khan Salim Surani Iqbal Ratnani Department of Medicine Queen Mary UniversityLondon E14NSUnited Kingdom Department of Medicine Aga Khan UniversitySindhKarachi 74500Pakistan Department of Medicine Jinnah Postgraduate Medical CenterSindhKarachi 75510Pakistan Department of Medicine and Pharmacology Texas A and M UniversityCollege StationTX 77843United States Department of Anesthesiology and Critical Care Houston Methodist HospitalHoustonTX 77030United States

Driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of ***,ΔP levels have also been shown to closely impact hard endpoints such as *** this,conducting an in-depth review ofΔP as a unique,outcome-impacting therapeutic modality is extremely *** is a need to understand the subtleties involved in making sureΔP levels are optimized to enhance outcomes and minimize *** performed this narrative review to further explore the various uses ofΔP,the different parameters that can affect its use,and how outcomes vary in different patient populations at different pressure *** better utilizeΔP in MV-requiring patients,additional large-scale clinical studies are needed.

关键词： Driving pressure Acute respiratory distress syndrome Mortality positive end-expiratory pressure Ventilator induced lung injury Mechanical ventilation

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Erroneous presentation of respiratory-hemodynamic disturbances and postsurgical inflammatory responses in patients having undergone abdominal cavity cancer surgery

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World Journal of Clinical Cases 2023年第18期11卷 4454-4457页

作者： Kaldybay S Idrissov Ospan A Mynbaev Department of General Practitioner South Kazakhstan Medical AcademyShymkent 160000Turkestanskaya OblKazakhstan Country Representative New European Surgical AcademyBerlin 121059Germany

In this letter to the editor,the authors discuss the findings and shortcomings of a published retrospective study,including 120 patients undergoing surgery for gastric or colon cancer under general *** study focused o... 详细信息

关键词： Dynamic respiratory-hemodynamic disturbances Postsurgical inflammatory responses:Gastric and colon cancer surgery positive end-expiratory pressure Peak airway pressure Mean airway pressure Dynamic pulmonary compliance

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Pulmonary complications and respiratory management in neurocritical care:a narrative review

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Chinese Medical Journal 2022年第7期135卷 779-789页

作者： Junxian Wen Jia Chen Jianbo Chang Junji Wei Department of Neurosurgery Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeDongcheng DistrictBeijing 100730China

Neurocritical care(NCC)is not only generally guided by principles of general intensive care,but also directed by specific goals and *** review summarizes the common pulmonary diseases and pathophysiology affecting NCC patients and the progress made in strategies of respiratory support in *** review highlights the possible interactions and pathways that have been revealed between neurological injuries and respiratory diseases,including the catecholamine pathway,systemic inflammatory reactions,adrenergic hypersensitivity,and dopaminergic *** complications of neurocritical patients include pneumonia,neurological pulmonary edema,and respiratory *** aspects of respiratory management include prioritizing the protection of the brain,and the goal of respiratory management is to avoid inappropriate blood gas composition levels and intracranial *** with the traditional mode of protective mechanical ventilation with low tidal volume(V_(t)),high positive end-expiratory pressure(PEEP),and recruitment maneuvers,low PEEP might yield a potential benefit in closing and protecting the lung *** neuromonitoring can ensure the safety of respiratory maneuvers in clinical and scientific *** studies are required to develop guidelines for respiratory management in NCC.

关键词： Neurocritical care Pneumonia Respiratory management Multimodel neuromonitoring Tracheostomy Mechanical ventilation positive end-expiratory pressure

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What Does a First Order Model Tell Us about PEEP Wave Maneuvers?

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Journal of Biomedical Science and Engineering 2017年第5期10卷 66-75页

作者： B.Laufer J.Kretschmer P.D.Docherty Y.S.Chiew K.Moller Institute of Technical Medicine Furtwangen UniversityVillingen-SchwenningenGermany Department of Mechanical Engineering University of CanterburyChristchurchNew Zealand School of Engineering Monash University MalaysiaBandar SunwayMalaysia

Patients with acute respiratory distress syndrome (ARDS) are currently treated with a lung protective ventilation strategy and the application of positive end-expiratory pressure (PEEP), sometimes in combination with recruitment maneuvers. In this study, the respiratory system elastance and airway resistance of each breath before, during and after a specific recruitment maneuver (PEEP wave maneuver) were analyzed in two patient groups, ARDS and control group. A reduction of elastance after the maneuver was observed in ARDS patients. In addition, only healthy lungs exhibited a reduction of the elastance during the course of the maneuver, while the lungs of ARDS patients didn’t show that reduction of elastance. The capability of PEEP wave maneuvers to improve lung ventilation was shown and the dynamic behavior of the elastance after the maneuver was illustrated. Healthy lungs adapt faster to changes in mechanical ventilation than the lungs of ARDS patients.

关键词： ARDS positive end-expiratory pressure Recruitment Maneuvers First Order Model Lung Mechanics

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