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Respiratory mechanics in brain-damaged patients
Antonia Koutsoukou1, Helen Perraki, Asimina Raftopoulou
1Department of Critical Care and Pulmonary Services, Evangelismos General Hospital and M Simou Laboratory, Medical School, University of Athens, Athens, Greece. koutsoukou@yahoo.gr
Intensive Care Medicine
|October 21, 2006
Summary
Brain-damaged patients on mechanical ventilation show abnormal respiratory mechanics. Moderate positive end-expiratory pressure (PEEP) prevents worsening lung injury, unlike zero PEEP (ZEEP).
Area of Science:
- Critical Care Medicine
- Respiratory Physiology
- Neurological Critical Care
Background:
- Mechanical ventilation is crucial for brain-damaged patients.
- Respiratory mechanics can be significantly altered in this population.
- The impact of positive end-expiratory pressure (PEEP) on respiratory mechanics in brain injury requires further investigation.
Purpose of the Study:
- To evaluate respiratory mechanics in brain-damaged patients on mechanical ventilation.
- To compare the effects of zero end-expiratory pressure (ZEEP) versus 8 cmH2O PEEP on respiratory mechanics.
- To assess changes in respiratory mechanics from day 1 to day 5 of ventilation.
Main Methods:
- A randomized controlled trial was conducted in a multidisciplinary intensive care unit.
- Twenty-one mechanically ventilated patients with severe brain damage were assigned to ZEEP or 8 cmH2O PEEP.
- Respiratory mechanics and arterial blood gases were measured on days 1 and 5.
Main Results:
- On day 1, ZEEP patients exhibited elevated static elastance and minimal resistance.
- After 5 days, ZEEP patients showed a significant increase in static elastance and minimal resistance, suggesting lung injury.
- The PEEP group demonstrated stable respiratory mechanics, and one ZEEP patient developed acute lung injury.
Conclusions:
- Brain-damaged patients on mechanical ventilation present with abnormal respiratory mechanics.
- Prolonged mechanical ventilation with ZEEP may lead to "low lung volume" injury.
- Moderate PEEP levels can prevent the deterioration of respiratory mechanics and lung injury in these patients.
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