Publication Date
9-1-2022
Journal
Journal of Applied Physiology
Abstract
The cerebral pressure reactivity index (PRx), through intracranial pressure (ICP) measurements, informs clinicians about the cerebral autoregulation (CA) status in adult-sedated patients with traumatic brain injury (TBI). Using PRx in clinical practice is currently limited by variability over shorter monitoring periods. We applied an innovative method to reduce the PRx variability by ventilator-induced slow (1/min) positive end-expiratory pressure (PEEP) oscillations. We hypothesized that, as seen in a previous animal model, the PRx variability would be reduced by inducing slow arterial blood pressure (ABP) and ICP oscillations without other clinically relevant physiological changes. Patients with TBI were ventilated with a static PEEP for 30 min (PRx period) followed by a 30-min period of slow [1/min (0.0167 Hz)] +5 cmH2O PEEP oscillations (induced (iPRx period). Ten patients with TBI were included. No clinical monitoring was discontinued and no additional interventions were required during the iPRx period. The PRx variability [measured as the standard deviation (SD) of PRx] decreased significantly during the iPRx period from 0.25 (0.22–0.30) to 0.14 (0.09–0.17) (P = 0.006). There was a power increase around the induced frequency (1/min) for both ABP and ICP (P = 0.002). In conclusion, 1/min PEEP-induced oscillations reduced the PRx variability in patients with TBI with ICP levels“optimal” perfusion pressure targets. Larger studies with prolonged periods of PEEP-induced oscillations are required to take it to routine use.
Keywords
Animals, Arterial Pressure, Brain Injuries, Brain Injuries, Traumatic, Cerebrovascular Circulation, Intracranial Pressure, Positive-Pressure Respiration
Included in
Mental and Social Health Commons, Pathological Conditions, Signs and Symptoms Commons, Trauma Commons
Comments
PMID: 35796613