Effects of PEEP on intracranial pressure in patients with acute brain injury: An observational, prospective and multicenter study

Med Intensiva (Engl Ed). 2024 Oct;48(10):594-601. doi: 10.1016/j.medine.2024.04.017. Epub 2024 May 29.

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).

Design: Observational, prospective and multicenter study (PEEP-PIC study).

Setting: Seventeen intensive care units in Spain.

Patients: Neurocritically ill patients who underwent invasive neuromonitorization from November 2017 to June 2018.

Interventions: Baseline ventilatory, hemodynamic and neuromonitoring variables were collected immediately before PEEP changes and during the following 30 min.

Main variables of interest: 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.

Keywords: Acute brain injury; Intracranial pressure; Lesión cerebral; Mechanical ventilation; Neurocritical care; Neurocríticos; Positive end-expiratory pressure; Presión intracraneal; Ventilación mecánica.

Publication types

  • Observational Study
  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Brain Injuries / complications
  • Brain Injuries / physiopathology
  • Brain Injuries, Traumatic / complications
  • Brain Injuries, Traumatic / physiopathology
  • Female
  • Hospital Mortality
  • Humans
  • Intracranial Pressure* / physiology
  • Male
  • Middle Aged
  • Positive-Pressure Respiration* / methods
  • Prospective Studies
  • Spain