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Related Experiment Videos

Intracranial responses to PEEP

S J Aidinis, J Lafferty, H M Shapiro

    Anesthesiology
    |September 1, 1976
    PubMed
    Summary

    Positive end-expiratory pressure (PEEP) can decrease cerebral perfusion pressure (CPP) and cause neurological issues. Pulmonary dysfunction may lessen these harmful effects, suggesting careful monitoring in patients with intracranial disease.

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    Area of Science:

    • Critical Care Medicine
    • Neurology
    • Pulmonary Medicine

    Background:

    • Positive end-expiratory pressure (PEEP) can increase intrathoracic pressure, potentially affecting intracranial pressure (ICP) and arterial blood pressure (BP).
    • This can critically reduce cerebral perfusion pressure (CPP = BP - ICP), posing risks in patients with intracranial conditions.

    Purpose of the Study:

    • To investigate the effects of graded PEEP levels on ICP, BP, and CPP in cats with induced intracranial masses.
    • To assess the influence of pulmonary dysfunction (induced by oleic acid embolization) on these cardiorespiratory and neurological parameters.

    Main Methods:

    • 15 cats with artificially induced intracranial masses were studied.
    • Graded levels of PEEP (5, 10, 15 cm H2O) were applied and removed, with continuous monitoring of ICP, arterial pressure, central venous pressure, electroencephalogram (EEG), and pupillary diameter.
    • Nine cats received intravenous oleic acid to induce pulmonary dysfunction.

    Main Results:

    • In non-embolized cats, PEEP caused significant CPP reduction (45 torr) and neurological changes (EEG abnormalities in 77%, pupillary dilation in 56%).
    • In oleic acid-embolized cats, CPP reduction was less severe (21 torr), and no EEG changes occurred due to PEEP.
    • Insignificant ICP increases (<1.5 torr) were common, but abrupt ICP rises (>11 torr) occurred in some animals, particularly with baseline ICP >15 torr.

    Conclusions:

    • PEEP can potentially cause neurological complications in patients with intracranial disease.
    • Pulmonary dysfunction may attenuate the adverse effects of PEEP on CPP and neurological function.
    • Monitoring neurological status, blood gases, and cardiovascular parameters during PEEP ventilation in patients with intracranial disease is recommended.

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