PDF(Pubmed)
Abstract：
UNASSIGNED: 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 models. ABI 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 outcome.
UNASSIGNED: The five-stage paradigm devised by Peters et al. and expanded by Arksey and O\'Malley, Levac et al., and the Joanna Briggs Institute was used for methodology. We also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension criteria. Inclusion 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 ABI. Exclusion 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 information. Two authors searched and screened for inclusion in papers published up to July 2023 using the PubMed-indexed online database. Data were presented in narrative and tubular form.
UNASSIGNED: The initial search yielded 330 references on the application of PEEP in ABI, of which 36 met our inclusion criteria. PEEP has recognized beneficial effects on gas exchange, but it produces hemodynamic changes that should be predicted to avoid undesired consequences on cerebral blood flow and intracranial pressure. Moreover, the elastic properties of the lungs influence the transmission of the forces applied by MV over the brain so they should be taken into consideration. Currently, there are no specific tools that can predict the effect of PEEP on the brain, but there is an established need for a comprehensive monitoring approach for these patients, acknowledging the etiology of ABI and the measurable variables to personalize MV.
UNASSIGNED: PEEP can be safely used in patients with ABI to improve gas exchange keeping in mind its potentially harmful effects, which can be predicted with adequate monitoring supported by bedside non-invasive neuromonitoring tools.
UNASSIGNED: The five-stage paradigm devised by Peters et al. and expanded by Arksey and O\'Malley, Levac et al., and the Joanna Briggs Institute was used for methodology. We also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension criteria. Inclusion 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 ABI. Exclusion 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 information. Two authors searched and screened for inclusion in papers published up to July 2023 using the PubMed-indexed online database. Data were presented in narrative and tubular form.
UNASSIGNED: The initial search yielded 330 references on the application of PEEP in ABI, of which 36 met our inclusion criteria. PEEP has recognized beneficial effects on gas exchange, but it produces hemodynamic changes that should be predicted to avoid undesired consequences on cerebral blood flow and intracranial pressure. Moreover, the elastic properties of the lungs influence the transmission of the forces applied by MV over the brain so they should be taken into consideration. Currently, there are no specific tools that can predict the effect of PEEP on the brain, but there is an established need for a comprehensive monitoring approach for these patients, acknowledging the etiology of ABI and the measurable variables to personalize MV.
UNASSIGNED: PEEP can be safely used in patients with ABI to improve gas exchange keeping in mind its potentially harmful effects, which can be predicted with adequate monitoring supported by bedside non-invasive neuromonitoring tools.
摘要：
■急性脑损伤（ABI）患者是一个特殊的人群，因为ABI不仅会影响大脑，还会影响其他器官，例如肺，如脑肺串扰模型中的理论。ABI患者通常需要机械通气（MV），以避免ABI后呼吸功能受损的并发症；由于MV对颅内室的影响，应谨慎处理。尤其是关于呼气末正压（PEEP）。本范围综述旨在（1）描述与PEEP在ABI中的作用相关的生理基础和机制；（2）研究如何在该主题上进行临床研究；（3）确定在ABI中设置PEEP的方法；（4）研究在ABI中应用PEEP对结果的影响。
■Peters等人设计的五阶段范式。并由Arksey和O\'Malley扩展,Levac等人。,乔安娜·布里格斯研究所被用于方法论。我们还遵守了系统审查和荟萃分析（PRISMA）扩展标准的首选报告项目。纳入标准：我们收集了来自同行评审期刊和研究的所有科学数据，这些研究讨论了PEEP的应用及其对颅内压的影响，脑灌注压,成人ABI患者的脑氧合。排除标准：仅检查儿科患者组（18岁以下）的研究，仅在动物上进行的实验；没有颅内压和/或脑灌注压测定的研究，和不完整信息的研究。两位作者使用PubMed索引的在线数据库搜索并筛选了截至2023年7月发表的论文。数据以叙述和管状形式呈现。
■最初的搜索产生了330个关于PEEP在ABI中应用的参考文献，其中36人符合我们的纳入标准。PEEP对气体交换有公认的有益效果，但它产生的血流动力学变化，应该预测，以避免对脑血流量和颅内压的不良后果。此外，肺部的弹性特性影响MV在大脑上施加的力的传递，因此应将其考虑在内。目前,没有特定的工具可以预测PEEP对大脑的影响，但是对于这些患者，需要一种全面的监测方法，承认ABI的病因和可测量的变量来个性化MV。
■PEEP可以安全地用于ABI患者，以改善气体交换，同时牢记其潜在的有害影响，这可以通过床边非侵入性神经监测工具支持的充分监测来预测。
■Peters等人设计的五阶段范式。并由Arksey和O\'Malley扩展,Levac等人。,乔安娜·布里格斯研究所被用于方法论。我们还遵守了系统审查和荟萃分析（PRISMA）扩展标准的首选报告项目。纳入标准：我们收集了来自同行评审期刊和研究的所有科学数据，这些研究讨论了PEEP的应用及其对颅内压的影响，脑灌注压,成人ABI患者的脑氧合。排除标准：仅检查儿科患者组（18岁以下）的研究，仅在动物上进行的实验；没有颅内压和/或脑灌注压测定的研究，和不完整信息的研究。两位作者使用PubMed索引的在线数据库搜索并筛选了截至2023年7月发表的论文。数据以叙述和管状形式呈现。
■最初的搜索产生了330个关于PEEP在ABI中应用的参考文献，其中36人符合我们的纳入标准。PEEP对气体交换有公认的有益效果，但它产生的血流动力学变化，应该预测，以避免对脑血流量和颅内压的不良后果。此外，肺部的弹性特性影响MV在大脑上施加的力的传递，因此应将其考虑在内。目前,没有特定的工具可以预测PEEP对大脑的影响，但是对于这些患者，需要一种全面的监测方法，承认ABI的病因和可测量的变量来个性化MV。
■PEEP可以安全地用于ABI患者，以改善气体交换，同时牢记其潜在的有害影响，这可以通过床边非侵入性神经监测工具支持的充分监测来预测。
