title: 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.
abstract: OBJECTIVE
  To verify whether high positive end-expiratory pressure levels can increase brain tissue oxygen pressure, and also their effects on pulse oxygen saturation, intracranial pressure, and cerebral perfusion pressure.
  
  
  METHODS
  Twenty traumatic brain injury patients with acute respiratory distress syndrome were submitted to positive end-expiratory pressure levels of 5, 10, and 15 cm H2O progressively. The 3 positive end-expiratory pressure levels were used during 20 minutes for each one, whereas brain tissue oxygen pressure, oxygen saturation, intracranial pressure, and cerebral perfusion pressure were recorded.
  
  
  RESULTS
  Brain tissue oxygen pressure and oxygen saturation increased significantly with increasing positive end-expiratory pressure from 5 to 10 and from 10 to 15 cm H2O (P=.0001 and P=.0001 respectively). Intracranial pressure and cerebral perfusion pressure did not differ significantly with increasing positive end-expiratory pressure from 5 to 10 and from 10 to 15 cm H2O (P=.16 and P=.79 respectively).
  
  
  CONCLUSIONS
  High positive end-expiratory pressure levels increased brain tissue oxygen pressure and oxygen saturation, without increase in intracranial pressure or decrease in cerebral perfusion pressure. High positive end-expiratory pressure levels can be used in severe traumatic brain injury patients with acute respiratory distress syndrome as a safe alternative to improve brain oxygenation.
authors: Complexo Hospitalar de Niterói. Rua La Salle 12, Centro, Niterói, Rio de Janeiro, CEP: 24020-090, Brazil; Hospital da Polícia Militar de Niterói. Rua Martins Torres 245, Santa Rosa, Niterói, Rio de Janeiro, CEP: 24240-705, Brazil; Universidade UNIGRANRIO. Rua José de Souza Herdy 1160, Jardim Vinte e Cinco de Agosto, Duque de Caxias, CEP: 25071-202, Brazil. Electronic address: snnemer@gmail.com.
authors: Sérgio Nogueira
authors: SN
authors: Nemer
authors: Complexo Hospitalar de Niterói. Rua La Salle 12, Centro, Niterói, Rio de Janeiro, CEP: 24020-090, Brazil; Universidade UNIGRANRIO. Rua José de Souza Herdy 1160, Jardim Vinte e Cinco de Agosto, Duque de Caxias, CEP: 25071-202, Brazil.
authors: Jefferson B
authors: JB
authors: Caldeira
authors: Complexo Hospitalar de Niterói. Rua La Salle 12, Centro, Niterói, Rio de Janeiro, CEP: 24020-090, Brazil.
authors: Ricardo G
authors: RG
authors: Santos
authors: Complexo Hospitalar de Niterói. Rua La Salle 12, Centro, Niterói, Rio de Janeiro, CEP: 24020-090, Brazil.
authors: Bruno L
authors: BL
authors: Guimarães
authors: Complexo Hospitalar de Niterói. Rua La Salle 12, Centro, Niterói, Rio de Janeiro, CEP: 24020-090, Brazil.
authors: João Márcio
authors: JM
authors: Garcia
authors: Complexo Hospitalar de Niterói. Rua La Salle 12, Centro, Niterói, Rio de Janeiro, CEP: 24020-090, Brazil.
authors: Darwin
authors: D
authors: Prado
authors: Complexo Hospitalar de Niterói. Rua La Salle 12, Centro, Niterói, Rio de Janeiro, CEP: 24020-090, Brazil.
authors: Ricardo T
authors: RT
authors: Silva
authors: Hospital da Polícia Militar de Niterói. Rua Martins Torres 245, Santa Rosa, Niterói, Rio de Janeiro, CEP: 24240-705, Brazil.
authors: Leandro M
authors: LM
authors: Azeredo
authors: Complexo Hospitalar de Niterói. Rua La Salle 12, Centro, Niterói, Rio de Janeiro, CEP: 24020-090, Brazil.
authors: Eduardo R
authors: ER
authors: Faria
authors: Complexo Hospitalar de Niterói. Rua La Salle 12, Centro, Niterói, Rio de Janeiro, CEP: 24020-090, Brazil.
authors: Paulo Cesar P
authors: PC
authors: Souza
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001921:Brain / Q000098:blood supply / Q000378:metabolism*; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D010865:Pilot Projects; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D012119:Respiration; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult
chemical_list: D010100:Oxygen
keywords: Acute respiratory distress syndrome; Brain injury; Mechanical ventilation