90th Annual Meeting Abstracts
The Effect of Positive End Expiratory Pressure on Traumatic Brain Injury
Suresh Agarwal, MD, *Karl Pilson, MD, *Patrick Kinnaird, BA, Peter Burke, MD
Boston University School of Medicine, Boston, MA
Objective: To determine PEEP's impact on patients with traumatic brain injury (TBI) who have an intra-cranial pressure (ICP) monitor in place.
Design: Five year retrospective review
Setting: Urban, Academic, Level I Trauma Center
Patients: TBI patients with Glasgow Coma Score (GCS) less than 9, ventilated, and monitored with an intra-cranial pressure monitor
Main Outcome Measures:
ICP measurements recorded as a percentage of day (hours/day) when greater than 15 mm Hg and 20 mm Hg. Amount of PEEP utilized, mortality, ventilatory parameters, paralytic usage, vasopressor requirement, operative procedures and in-hospital morbidity.
Results: 70 patients met criteria, 51% received PEEP, 17.14% patients received NO PEEP, the remainder included patients in whom PEEP was started during the hospital course. ICP’s were noted to exceed 15 mm Hg 46.44% of the time on PEEP vs. 52.25% with NO PEEP. ICP’s exceeded 20 mm Hg 29.96% of the time with PEEP and 32% with NO PEEP. Cerebral perfusion pressure (CPP) dropped below 60 mm hg. 15.10% of the time with PEEP and 11.96% with NO PEEP. Pressor were required 21% of the time with NO PEEP and 38% of the time with PEEP. Injury severity scores were similar for the two groups: mean ISS of 23.12 (no PEEP) and 24.22 for PEEP; Mean AIS for TBI 8.73 for no PEEP and 8.08 for PEEP.
Conclusions: PEEP usage is safe in severe TBI patients who have ICP monitors. CPP Reductions and increased pressor requirement when using PEEP warrant further study in a randomized, prospective manner.