Abstract：
OBJECTIVE: To analyze the impact of positive end-expiratory pressure (PEEP) changes on intracranial pressure (ICP) dynamics in patients with acute brain injury (ABI).
METHODS: Observational, prospective and multicenter study (PEEP-PIC study).
METHODS: Seventeen intensive care units in Spain.
METHODS: Neurocritically ill patients who underwent invasive neuromonitorization from November 2017 to June 2018.
METHODS: Baseline ventilatory, hemodynamic and neuromonitoring variables were collected immediately before PEEP changes and during the following 30 min.
METHODS: PEEP and ICP changes.
RESULTS: One-hundred and nine patients were included. Mean age was 52.68 (15.34) years, male 71 (65.13%). Traumatic brain injury was the cause of ABI in 54 (49.54%) patients. Length of mechanical ventilation was 16.52 (9.23) days. In-hospital mortality was 21.1%. PEEP increases (mean 6.24-9.10 cmH2O) resulted in ICP increase from 10.4 to 11.39 mmHg, P < .001, without changes in cerebral perfusion pressure (CPP) (P = .548). PEEP decreases (mean 8.96 to 6.53 cmH2O) resulted in ICP decrease from 10.5 to 9.62 mmHg (P = .052), without changes in CPP (P = .762). Significant correlations were established between the increase of ICP and the delta PEEP (R = 0.28, P < .001), delta driving pressure (R = 0.15, P = .038) and delta compliance (R = -0.14, P = .052). ICP increment was higher in patients with lower baseline ICP.
CONCLUSIONS: PEEP changes were not associated with clinically relevant modifications in ICP values in ABI patients. The magnitude of the change in ICP after PEEP increase was correlated with the delta of PEEP, the delta driving pressure and the delta compliance.
METHODS: Observational, prospective and multicenter study (PEEP-PIC study).
METHODS: Seventeen intensive care units in Spain.
METHODS: Neurocritically ill patients who underwent invasive neuromonitorization from November 2017 to June 2018.
METHODS: Baseline ventilatory, hemodynamic and neuromonitoring variables were collected immediately before PEEP changes and during the following 30 min.
METHODS: PEEP and ICP changes.
RESULTS: One-hundred and nine patients were included. Mean age was 52.68 (15.34) years, male 71 (65.13%). Traumatic brain injury was the cause of ABI in 54 (49.54%) patients. Length of mechanical ventilation was 16.52 (9.23) days. In-hospital mortality was 21.1%. PEEP increases (mean 6.24-9.10 cmH2O) resulted in ICP increase from 10.4 to 11.39 mmHg, P < .001, without changes in cerebral perfusion pressure (CPP) (P = .548). PEEP decreases (mean 8.96 to 6.53 cmH2O) resulted in ICP decrease from 10.5 to 9.62 mmHg (P = .052), without changes in CPP (P = .762). Significant correlations were established between the increase of ICP and the delta PEEP (R = 0.28, P < .001), delta driving pressure (R = 0.15, P = .038) and delta compliance (R = -0.14, P = .052). ICP increment was higher in patients with lower baseline ICP.
CONCLUSIONS: PEEP changes were not associated with clinically relevant modifications in ICP values in ABI patients. The magnitude of the change in ICP after PEEP increase was correlated with the delta of PEEP, the delta driving pressure and the delta compliance.
摘要：
目的：分析呼气末正压（PEEP）变化对急性脑损伤（ABI）患者颅内压（ICP）动力学的影响。
方法：观察性，前瞻性和多中心研究（PEEP-PIC研究）。
方法：西班牙17个重症监护病房。
方法：2017年11月至2018年6月接受侵入性神经监测的神经危重患者。
方法：基线通气，在PEEP改变之前和之后的30分钟内收集血液动力学和神经监测变量。
方法：PEEP和ICP变化。
结果：纳入了109名患者。平均年龄为52.68（15.34）岁，男性71人(65.13%)。在54例（49.54%）患者中，创伤性脑损伤是ABI的原因。机械通气时间为16.52(9.23)天。住院死亡率为21.1%。PEEP增加（平均6.24-9.10cmH2O）导致ICP从10.4增加到11.39mmHg，P<.001，脑灌注压（CPP）无变化（P=.548）。PEEP降低（平均8.96至6.53cmH2O）导致ICP从10.5mmHg降低至9.62mmHg（P=0.052），CPP无变化（P=.762）。ICP的增加与ΔPEEP之间建立了显着的相关性（R=0.28，P<.001），delta驱动压力(R=0.15,P=.038)和delta顺应性(R=-0.14,P=.052)。基线ICP较低的患者的ICP增量较高。
结论：PEEP改变与ABI患者ICP值的临床相关改变无关。PEEP增加后ICP的变化幅度与PEEP的增量相关，三角洲驱动压力和三角洲顺应性。
方法：观察性，前瞻性和多中心研究（PEEP-PIC研究）。
方法：西班牙17个重症监护病房。
方法：2017年11月至2018年6月接受侵入性神经监测的神经危重患者。
方法：基线通气，在PEEP改变之前和之后的30分钟内收集血液动力学和神经监测变量。
方法：PEEP和ICP变化。
结果：纳入了109名患者。平均年龄为52.68（15.34）岁，男性71人(65.13%)。在54例（49.54%）患者中，创伤性脑损伤是ABI的原因。机械通气时间为16.52(9.23)天。住院死亡率为21.1%。PEEP增加（平均6.24-9.10cmH2O）导致ICP从10.4增加到11.39mmHg，P<.001，脑灌注压（CPP）无变化（P=.548）。PEEP降低（平均8.96至6.53cmH2O）导致ICP从10.5mmHg降低至9.62mmHg（P=0.052），CPP无变化（P=.762）。ICP的增加与ΔPEEP之间建立了显着的相关性（R=0.28，P<.001），delta驱动压力(R=0.15,P=.038)和delta顺应性(R=-0.14,P=.052)。基线ICP较低的患者的ICP增量较高。
结论：PEEP改变与ABI患者ICP值的临床相关改变无关。PEEP增加后ICP的变化幅度与PEEP的增量相关，三角洲驱动压力和三角洲顺应性。
