Intracranial Pressure During Pressure Control and Pressure-Regulated Volume Control Ventilation in Patients with Traumatic Brain Injury: A Randomized Crossover trial.
Mechanical ventilation with control of partial arterial CO2 pressures (PaCO2) is used to treat or stabilize intracranial pressure (ICP) in patients with traumatic brain injury (TBI). Pressure-regulated volume control (PRVC) is a ventilator mode where inspiratory pressures are automatically adjusted to deliver the patient a pre-set stable tidal volume (TV). This may result in a more stable PaCO2 and thus a more stable ICP compared with conventional pressure control (PC) ventilation. The aim of this study was to compare PC and PRVC ventilation in TBI patients with respect to ICP and PaCO2.



This is a randomized crossover trial including eleven patients with a moderate or severe TBI who were mechanically ventilated and had ICP monitoring. Each patient was administered alternating 2-h periods of PC and PRVC ventilation. The outcome variables were ICP and PaCO2.



Fifty-two (26 PC, 26 PRVC) study periods were included. Mean ICP was 10.8 mmHg with PC and 10.3 mmHg with PRVC ventilation (p = 0.38). Mean PaCO2 was 36.5 mmHg (4.87 kPa) with PC and 36.1 mmHg (4.81 kPa) with PRVC (p = 0.38). There were less fluctuations in ICP (p = 0.02) and PaCO2 (p = 0.05) with PRVC ventilation.



Mean ICP and PaCO2 were similar for PC and PRVC ventilation in TBI patients, but PRVC ventilation resulted in less fluctuation in both ICP and PaCO2. We cannot exclude that the two ventilatory modes would have impact on ICP in patients with higher ICP values; however, the similar PaCO2 observations argue against this.
Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, 7491, Trondheim, Norway. kari.schirmer-mikalsen@ntnu.no.|Department of Anaesthesiology and Intensive Care Medicine, St. Olav University Hospital, Pb 3250 Sluppen, 7006, Trondheim, Norway. kari.schirmer-mikalsen@ntnu.no.
Kari
K
Schirmer-Mikalsen
Department of Neurosurgery, St. Olav University Hospital, Pb 3250 Sluppen, 7006, Trondheim, Norway.|Department of Neuroscience, Norwegian University of Science and Technology, 7491, Trondheim, Norway.
Anne
A
Vik
Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, 7491, Trondheim, Norway.|Department of Anaesthesiology and Intensive Care Medicine, St. Olav University Hospital, Pb 3250 Sluppen, 7006, Trondheim, Norway.
Eirik
E
Skogvoll
Department of Neuroscience, Norwegian University of Science and Technology, 7491, Trondheim, Norway.|Department of Medical Imaging, St. Olav University Hospital, Pb 3250 Sluppen, 7006, Trondheim, Norway.
Kent Gøran
KG
Moen
Department of Neurosurgery, St. Olav University Hospital, Pb 3250 Sluppen, 7006, Trondheim, Norway.|Department of Neuroscience, Norwegian University of Science and Technology, 7491, Trondheim, Norway.
Ole
O
Solheim
Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, 7491, Trondheim, Norway.|Department of Anaesthesiology and Intensive Care Medicine, St. Olav University Hospital, Pb 3250 Sluppen, 7006, Trondheim, Norway.
Pål
P
Klepstad
D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D003422:Critical Care / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011175:Positive-Pressure Respiration / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods*; D013990:Tidal Volume / Q000502:physiology*; D055815:Young Adult
Brain injuries; Critical care; Intensive care; Intracranial pressure; Respiratory treatment