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Positive endexpiratory pressure (peep) influences on intracranial pressure, systemic hemodynamics and pulmonary gas exchange in patients with intracranial hemorrhage in critical state


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Abstract

Positive end-expiratory pressure is one of the main parameters of respiratory support influencing the gas exchange. However, despite the number ofpositive effects, PEEP can compromise venous outflow from the cranial cavity, increased intracranial pressure, decreased venous return and cardiac output and, consequently, reduced blood pressure and cerebral perfusion. The article presents the results of a survey of 39 patients with intracranial hemorrhage in critical state, undergoing respiratory support with different levels of positive end-expiratory pressure. Increasing of PEEP to 15 cmH2O had no adverse effect on mean arterial pressure, heart rate and cerebral perfusion pressure and led only to an clinical insignificant increase (maximum on 2,4 ± 5,1 mmHg) in intracranial pressure. The greatest hemodynamic changes were observed with increasing PEEP up to 20 cmH2O in patients with preserved compliance of the respiratory system. The instability of cerebral perfusion and intracranial pressure associated with a decrease in cardiac output and preload and the exhaustion of compensatory mechanism ofperipheral vascular resistance. High levels of PEEP, despite the trend towards Cstat reduction will not lead to an increase in the content of extravascular lung water. Thus a gradual increase of PEEP to 15 cmH2O can be safe and effective method of improving pulmonary gas exchange in patients with intracranial hemorrhage in critical state.


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