Effects of positive end-expiratory pressure on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation*

  title={Effects of positive end-expiratory pressure on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation*},
  author={Elke Muench and Christian Bauhuf and Harry Roth and Peter Horn and Mark Phillips and Natali Marquetant and Michael Quintel and Peter Vajkoczy},
  journal={Critical Care Medicine},
Objective:Acute respiratory dysfunction frequently occurs following severe aneurysmal subarachnoid hemorrhage requiring positive end-expiratory pressure (PEEP) ventilation to maintain adequate oxygenation. High PEEP levels, however, may negatively affect cerebral perfusion. The goal of this study was, to examine the influence of various PEEP levels on intracranial pressure, brain tissue oxygen tension, regional cerebral blood flow, and systemic hemodynamic variables. Design:Animal research and… 
Impact of positive end-expiratory pressure on cerebral injury patients with hypoxemia.
Influence of PEEP on Cerebral Blood Flow and Cerebrovascular Autoregulation in Patients With Acute Respiratory Distress Syndrome
Surprisingly, AR was impaired in 55% of the patients with ARDS, and should be taken into account when managing cerebral perfusion pressure to avoid cerebral hyperperfusion or hypoperfusion.
Effects of high positive end‐expiratory pressure on haemodynamics and cerebral oxygenation during pneumoperitoneum in the Trendelenburg position
The application of 10 cmH2O positive end‐expiratory pressure during pneumoperitoneum in the Trendelenburg position preserved regional cerebral oxygen saturation, but cerebral perfusion pressure decreased significantly due to its secondary haemodynamic effects.
Impact of Altered Airway Pressure on Intracranial Pressure, Perfusion, and Oxygenation: A Narrative Review
The effects of airway pressure and ventilation on cerebral perfusion and oxygenation are increasingly understood, especially in the setting of brain injury, and multimodal monitoring and individualized titration will increasingly be required to optimize care.
Comparison of the Effects of Different Positive End-Expiratory Pressure Levels on Cerebral Oxygen Saturation With Near Infrared Spectroscopy During Laparoscopic Cholecystectomy
It is considered that both 5 and 10 cm H2O PEEP levels can be safely used during PP applied during laparoscopic surgery, without affecting hemodynamics, and without causing a decline in rSO2.
Intracranial-to-Central Venous Pressure Gap Predicts the Responsiveness of ICP to PEEP in Patients with Traumatic Brain Injury
The impact of PEEP on ICP depends on the GAP of between baseline ICP and baseline CVP, i.e. PICGap, which could be a potential predictor for ICP responsiveness to PEEP adjustment in patients with sTBI.
Measurement of Cerebral Blood Flow Autoregulation with Rheoencephalography: A Comparative Pig Study
The clinical significance of this animal study is that REG shows potential for use as a noninvasive, continuous and non-operator dependent neuromonitor of CBF AR in both civilian and military medical settings.
Intracranial-to-central venous pressure gap predicts the responsiveness of intracranial pressure to PEEP in patients with traumatic brain injury: a prospective cohort study
P IC Gap is a potential predictor of ICP responsiveness to PEEP adjustment in patients with sTBI, with favorable sensitivity and specificity compared with baseline ICP and baseline CVP.


Effects of varying levels of positive end-expiratory pressure on intracranial pressure and cerebral perfusion pressure.
In patients with normal intracranial pressure, PEEP at 5 cm H2O did not significantly alter intrac Cranial pressure and cerebral perfusion pressure, and in patients with increased intrusion pressure, higher levels of PEEP did not significant change intrac cranial pressure or cerebral perfusions pressure.
Influence of Positive End-Expiratory Pressure on Intracranial Pressure and Cerebral Perfusion Pressure in Patients With Acute Stroke
PEEP increase up to 12 mm Hg does not significantly influence ICP, and the observed marked changes in CPP are mediated through the MAP, suggesting that PEEP application should be safe, provided that MAP is maintained.
The Effect of Positive End‐Expiratory Pressure Ventilation (PEEP) on Cerebral Blood Flow and Cerebrospinal Fluid Pressure in Goats
It is concluded that brain interstitial fluid pressure is an important variable in the determination of cerebral blood flow during ventilation with PEEP and when PEEP therapy is associated with substantial decreases in BP and CO, CBF may decrease as well.
The Effect of Continuous Positive Airway Pressure on Cerebral Blood Flow Velocity in Awake Volunteers
The study implies that the application of continuous positive airway pressure (CPAP) does not affect transcranial Doppler monitoring of the middle cerebral artery blood flow velocity and that the effect of CPAP on cerebral hemodynamics is less than had been previously suggested.
Regional cerebral blood flow monitoring in the diagnosis of delayed ischemia following aneurysmal subarachnoid hemorrhage.
Thermal-diffusion flowmetry represents a promising method for the bedside monitoring of patients with SAH to detect symptomatic vasospasm and was characterized by a more favorable diagnostic reliability than transcranial Doppler ultrasonography.
Continuous intracranial multimodality monitoring comparing local cerebral blood flow, cerebral perfusion pressure, and microvascular resistance.
It is concluded that with disrupted autoregulation, CPP above 70 mmHg does not necessarily insure adequate levels of cerebral perfusion and restoration and maintenance of adequate cerebral perfusions should be performed under the guidance of direct CBF monitoring.
Continuous positive airway pressure breathing increases cerebral blood flow velocity in humans.
The effect of a continuous positive airway pressure (CPAP) of 12 cm H2O on mean middle cerebral artery flow velocity (CBFV) was studied in nine human volunteers by means of transcranial Doppler
Safe use of PEEP in patients with severe head injury.
It is concluded that 10 cm H2O PEEP increases ICP slightly via its effect on other physiological variables, but that this small increase in ICP is clinically inconsequential.
Autoregulation of Cerebral Blood Flow in Experimental Focal Brain Ischemia
  • U. Dirnagl, W. Pulsinelli
  • Medicine
    Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism
  • 1990
It is demonstrated that the relationship between CBF and SAP in areas of focal ischemia is highly dependent on the severity of ischemIA, and autoregulation is lost in a gradual manner until CBF falls below 30% of normal.
Spontaneous oscillations of arterial blood pressure, cerebral and peripheral blood flow in healthy and comatose subjects.
The CoV reduction in peripheral LDF and ABP oscillations suggest a severe impairment of the proposed sympathetic pathway in comatose patients, and the preservation of central TCD oscillations argues in favor of different pathways and/or generators of cerebral and peripheral B- and M-waves.