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NEUROLOGIC EMERGENCY  SMART 2002 Milan, May 29-31, 2002 Freefree

Minerva Anestesiologica 2002 April;68(4):291-6

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Respiratory mechanics in brain injured patients

Gamberoni C., Colombo G., Aspesi M., Mascheroni C., Severgnini P., Minora G., Pelosi P., Chiaranda M.

From the Università degli Studi dell’Insubria Dipartimento di Scienze Cliniche e Biologiche Servizio di Anestesia e Rianimazione B Ospedale di Circolo e Fondazione Macchi, Varese (Italy)


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Back­ground. ­Brain ­injured ­patients ­have an ­increased ­risk of extra­cer­e­bral ­organ fail­ure, main­ly pul­mo­nary dys­func­tion. The prev­a­lent ­cause of pul­mo­nary fail­ure is ven­ti­la­tor asso­ciat­ed pneu­mo­nia (VAP) ­which increas­es mor­bid­ity and mor­tal­ity. The res­pir­a­to­ry dys­func­tion is main­ly char­ac­ter­ized by the pres­ence of alveo­lar con­sol­i­da­tion of the depen­dent ­lobes.
Meth­ods. We inves­ti­gat­ed the mechan­i­cal chang­es of the res­pir­a­to­ry ­system and the ­effects of pos­i­tive end-expir­a­to­ry pres­sure (­PEEP) in 10 nor­mal sub­jects, in 10 ­brain ­injured ­patients with­out res­pir­a­to­ry fail­ure and in 10 ­brain ­injured ­patients ­with res­pir­a­to­ry fail­ure (PaO2/FiO2 low­er ­than 200 ­mmHg) due to VAP.
­Results. We ­found ­that: 1) Inta­ra-Abdom­i­nal Pres­sure (IAP) was ­increased in ­brain ­injured ­patients ­with or with­out res­pir­a­to­ry fail­ure com­pared to nor­mal sub­jects; 2) the Elas­tance of res­pir­a­to­ry ­system (Est,rs), the Elas­tance of the ­chest ­wall (Est,cw) and Resis­tence max of the ­Lung (­Rmax,L) ­increased in ­brain ­injured ­patients inde­pen­dent­ly ­from the pres­ence of res­pir­a­to­ry fail­ure; 3) in ­brain ­injured ­patients ­with res­pir­a­to­ry fail­ure appli­ca­tion of 15 cmH2O of ­PEEP ­increased the Elas­tance of the ­Lung (Est,L), Est,rs and ­Rmax,L, ­while did not ­result in sig­nif­i­cant alveo­lar recruit­ment and oxy­gen­a­tion improve­ment.
Con­clu­sions. In con­clu­sion, in ­brain ­injured ­patients 1) the res­pir­a­to­ry mechan­ics is ­altered; 2) ­PEEP is unef­fec­tive to ­improve res­pir­a­to­ry func­tion in res­pir­a­to­ry fail­ure due to ven­ti­la­tor asso­ciat­ed pneu­mo­nia. Fur­ther stud­ies are war­rant­ed to bet­ter elu­ci­date the pathoph­y­sio­lo­gy and clin­i­cal man­age­ment of res­pir­a­to­ry dys­func­tion in ­brain ­injured ­patients.

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