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Repercuss?o da press?o positiva expiratória final na press?o de perfus?o cerebral em pacientes adultos com acidente vascular hemorrágico

DOI: 10.1590/S0103-507X2011000300006

Keywords: intracranial pressure, positive-pressure respiration, stroke.

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Abstract:

positive intrathoracic pressure may cause hemodynamic changes, which can be transmitted to the cranial compartment, changing intracranial pressure and cerebral perfusion pressure. this can be increased when high positive end-expiratory pressure values are used. objective: to measure the impact of different positive end-expiratory pressure levels on intracranial pressure, cerebral perfusion pressure and mean blood pressure. method: this study was conducted in a neurological intensive care unit and included 25 adult hemorrhagic stroke patients who were mechanically ventilated on airway pressure control mode. patients were subjected to various positive end-expiratory values ranging between 0 and 14 cmh2o. the order of these values were randomized, and the variables were assessed five minutes after each new positive end-expiratory pressure level was initiated. results: incremental positive end-expiratory pressures led to increased intracranial pressure (p < 0.001), however, no statistically significant changes were observed in mean blood pressure or cerebral perfusion pressure. conclusion: in this population of patients with hemorrhagic stroke, positive end-expiratory pressure values up to 14 cmh2o did not alter cerebral perfusion pressure or mean blood pressure. increased intracranial pressures were noted, although these elevations were not clinically significant

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