- 1 Burdenko National Research Center of Neurosurgery, Moscow, Russia
- 2 Lomonosov Moscow State University, Moscow, Russia
- 3 I. M. Sechenov First Moscow State Medical University, Moscow, Russia
The literature review describes current approaches to management of patients with acute cerebral lesions and intracranial hypertension, complicated by acute respiratory distress syndrome (ARDS).
It presents the stages of ventilation strategy evolution in patients with ARDS. The effect of the increase in intrathoracic pressure on system hemodynamics parameters during artificial pulmonary ventilation (APV) is demonstrated. The data on changes in venous return and arterial pressure are presented. The review describes the current understanding of the correlation between pulmonary mechanics and central hemodynamics and effect of these factors on cerebral hemodynamics. The brief description of intracranial tension and cerebral compliance is given.
The publication presents the results of up-to-date studies on specific parameters of PEEP optimization in the patients with concurrent acute cerebral lesions, intracranial hypertension, and development of ARDS. Numerous studies were devoted to optimization of APV in case of ARDS, but currently one can not unambiguously conclude about the safe level of PEEP if there is intracranial hypertension.
The authors of the article agree with the opinion that more prospective randomized studies are needed and advanced multi-parameter cerebral monitoring is required in case of concurrent pulmonary and cerebral disorders.
Key Words: acute respiratory distress syndrome, positive end expiration pressure, intracranial pressure, intracranial hypertension, cerebral edema
- 1.Gritsan А.I., Kolesnichenko А.P., Vlasenko А.V. et al. Diagnostika i differentsirovannoe lechenie ostrogo respiratornogo distress-sindroma. Klinicheskie rekomendatsii. [Diagnostics and differential treatment of acute respiratory distress syndrome. Clinical Recommendations]. 2015, pp. 5–6, 13–14.
- 2.Albaiceta G.M., Blanch L., Lucangelo U. Static pressure-volume curves of the respiratory system: were they just a passing fad? Curr. Opin. Crit. Care, 2008, vol. 14, no. 1, pp. 80-86.
- 3.Apuzzo J.L., Wiess M.H., Petersons V. et al. Effect of positive end expiratory pressure ventilation on intracranial pressure in man. J. Neurosurg., 1977, vol. 46, no. 2, pp. 227-232.
- 4.Barami K., Sood S. The cerebral venous system and the postural regulation of intracranial pressure: implications in the management of patients with cerebrospinal fluid diversion. Childs. Nerv. Syst., 2016, vol. 32, no. 4, pp. 599-607.
- 5.Boone M.D., Jinadasa S.P., Mueller A. et al. The effect of positive end–expiratory pressure on intracranial pressure and cerebral hemodynamics. Neurocrit Care, 2017, vol. 26, no. 2, pp. 174-181.
- 6.Boussarsar M., Thierry G., Jaber S. et al. Relationship between ventilatory settings and barotrauma in the acute respiratory distress syndrome. Intens. Care Med., 2002, vol. 28, no. 4, pp. 406-413.
- 7.Brian J.E.J. Carbon dioxide and the cerebral circulation. Anesthesiology, 1998, vol. 88, pp. 1365-1386.
- 8.Brower R.G., Matthay M.A., Morris A. et al. Acute Respiratory Distress Syndrome Network, Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N. Engl. J. Med., 2000, vol. 342, no. 18, pp. 1301-1308.
- 9.Burchiel K.J., Steege T.D., Wyler A.R. Intracranial pressure changes in brain-injured patients requiring positive end-expiratory pressure ventilation. Neurosurgery, 1981, vol. 8, pp. 443-449.
- 10.Caironi P. Lung recruitment maneuvers during acute respiratory distress syndrome: open up but not push-up the lung! Minerva Anestesiol., 2011, vol. 77, no. 12, pp. 1134-1136.
- 11.Caricato A., Conti G., Della Corte F. et al. Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: the role of respiratory system compliance. J. Trauma, 2005, vol. 58, pp. 571-576.
- 12.Carney N., Totten A.M., O'Reilly C. et al. Guidelines for the Management of Severe Traumatic Brain Injury 4th Edition. Neurosurgery, 2017, vol. 80, no. 1, pp. 6-15.
- 13.Cherniack R.M., Farhi L.E., Armstrong B.W. et al. A comparison of esophageal and intrapleural pressure in man. J. Appl. Physiol., 1955, vol. 8, pp. 203-211.
- 14.Cressoni M., Chiumello D., Carlesso E. et al. Compressive forces and computed tomography-derived positive end-expiratory pressure in acute respiratory distress syndrome. Anesthesiology, 2014, vol. 121, pp. 572-581.
- 15.Czosnyka M., Brady K., Reinhard M. et al. Monitoring of cerebrovascular autoregulation: facts, myths, and missing links. Neurocrit. Care, 2009, vol. 10, no. 3, pp. 373-386.
- 16.Czosnyka M., Pickard J.D. Monitoring and interpretation of intracranial pressure. J. Neurol. Neurosurg. Psychiatry, 2004, vol. 75, pp. 813-821.
- 17.Demory D., Arnal J.-M., Wysocki M. et al. Recruitability of the lung estimated by the pressure volume curve hysteresis in ARDS patients. Intens. Care Med., 2008, vol. 16, pp. 2019-2025.
- 18.Fish E., Novack V., Banner-Goodspeed V.M. et al. The Esophageal Pressure-Guided Ventilation 2 (EPVent2) trial protocol: a multicentre, randomised clinical trial of mechanical ventilation guided by transpulmonary pressure. BMJ Open, 2014, vol. 4, no. 10. http://doi.org/10.1136/bmjopen-2014-006356
- 19.Frost E.A. Effects of positive end-expiratory pressure on intracranial pressure and compliance in brain-injured patients. J. Neurosurg., 1977, vol. 47, pp. 195-200.
- 20.Garnero A., Tuxen D., Corno G. et al. Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients. Crit. Care, 2015, vol. 19, no. 1, pp. 340.
- 21.Gattinoni L., Quintel M. How ARDS should be treated. Crit. Care, 2016, vol. 20, no. 86, – URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822276/
- 22.Hata J.S., Togashi K., Kumar A.B. et al. The effect of the pressure–volume curve for positive end–expiratory pressure titration on clinicaloutcomes in acute respiratory distress syndrome: a systematic review. J. Intens. Care Med., 2014, vol. 29, no. 6, pp. 348-356.
- 23.Hess D.R. Recruitment Maneuvers and PEEP Titration. Respir. Care, 2015. vol. 60, pp. 1688-1704.
- 24.Hickling K.G. Best compliance during a decremental, but not incremental, positive end-expiratory pressure trial is related to open-lung positive end-expiratory pressure: a mathematical model of acute respiratory distress syndrome lungs. Am. J. Respir. Crit. Care Med., 2001, vol. 163, pp. 69-78.
- 25.Huseby J.S., Pavlin E.G., Butler J. Effect of positive end–expiratory pressure on intracranial pressure in dogs. J. Appl. Physiol. Respir. Environ. Exerc. Physiol., 1978, vol. 44, no. 1, pp. 25-27.
- 26.Kawoos U., McCarron R.M., Auker C.R. et al. Advances in intracranial pressure monitoring and its significance in managing traumatic brain injury. Int. J. Molec. Sci., 2015, vol. 16, no. 12, pp. 28979-28997.
- 27.Keenan J.C., Formenti P., Marini J.J. Lung recruitment in acute respiratory distress syndrome: what is the best strategy? Curr. Opin. Crit. Care, 2014, vol. 20, no. 1, pp. 63-68.
- 28.Keller S.P., Fessler H.E. Monitoring of oesophageal pressure. Curr. Opin. Crit. Care, 2014, vol. 20, no. 3, pp. 340-346.
- 29.Lou M., Xue F., Chen L. et al. Is high PEEP ventilation strategy safe for acute respiratory distress syndrome after severe traumatic brain injury? Brain. Inj. 2012, vol. 26, pp. 887-890.
- 30.Madden J.A. The effect of carbon dioxide on cerebral arteries. Pharmacol Ther., 1993, vol. 59, pp. 229-250.
- 31.Mascia L. Acute lung injury in patients with severe brain injury: a double hit model. Neurocrit Care, 2009, vol. 11, pp, 417-426.
- 32.Mercat A., Richard J.C.M., Vielle B. et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA, 2008, vol. 299, no. 646, pp. 55.
- 33.Milic-Emili J., Mead J., Turner J.M. et al. Improved technique for estimating pleural pressure from esophageal balloons. J. Appl. Physiol., 1964, vol. 19, pp. 207-211.
- 34.Miller J.D., Leech P. Effects of mannitol and steroid therapy on intracranial volume-pressure relationships in patients. J. Neurosurg., 1975, vol. 42, pp. 274-281.
- 35.Nemer S.N. Effects of positive end-expiratory pressure on brain tissue oxygen pressure of severe traumatic brain injury patients with acute respiratory distress syndrome: a pilot study. J. Crit. Care, 2015, vol. 30, no. 6, pp. 1263-1266.
- 36.Pelosi P. Sigh in acute respiratory distress syndrome. Am. J. Respir. Crit. Care Med., 1999, vol. 159, no. 3, pp. 872-880.
- 37.Pestana D., Hernández-Gancedo C., Royo C. et al. Adjusting positive end–expiratory pressure and tidal volume in acute respiratory distress syndrome according to the pressure–volume curve. Acta Anaesthesiologica Scandinavica, 2003, vol. 47, no. 3, pp. 326-334.
- 38.Pestaña D., Hernández-Gancedo C., Royo C. et al. Pressure-volume curve variations after a recruitment manoeuvre in acute lung injury/ARDS patients: implications for the understanding of the inflection points of the curve. Eur. J. Anaesthesiol., 2005, vol. 22, no. 3, pp. 175-180.
- 39.Rocco P.R., Pelosi P., de Abreu M.G. Pros and cons of recruitment maneuvers in acute lung injury and acute respiratory distress syndrome. Exp. Rev. Respir. Med., 2010, vol. 4, no. 4, pp. 479-489.
- 40.Sahetya S.K., Brower R.G. The promises and problems of transpulmonary pressure measurements in acute respiratory distress syndrome. Curr. Opin. Crit. Care, 2016, vol. 22, no. 1, pp. 7-13.
- 41.Shapiro H.M., Marshall L.F. Intracranial pressure responses to PEEP in head–injured patients. J. Trauma Acute Care Surg., 1978, vol. 18, pp. 254-256.
- 42.Smith M. Monitoring intracranial pressure in traumatic brain injury. Anesth Analg., 2008, vol. 106, no. 1, pp. 240-248.
- 43.Talmor D., Sarge T., Malhotra A. et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. New Engl. J. Med., 2008, vol. 359, no. 20, pp. 2095-2104.
- 44.Thomas P. Decremental PEEP titration: a step away from the table. Respirat. Care, 2013, vol. 58, no. 5, pp. 886-888.
- 45.Wildberg A.L., Campelo A.R., Gomes R.L. The impact of positive end-expiratory pressure on cerebral perfusion pressure in adult patients with hemorrhagic stroke. Rev. Bras. Ter. Intensiva, 2011, vol. 23, no. 3, pp. 291-296.
- 46.Wilson M.H., Monro-Kellie 2.0: The dynamic vascular and venous pathophysiological components of intracranial pressure. J. Cereb. Blood Flow Metab., 2016, vol. 36, pp. 1338-1350.