Safety of flow-controlled ventilation with positive and negative end-expiratory pressure in a swine model of intracranial hypertension
Abstract Background Patients with brain damage often require mechanical ventilation. Although lung-protective ventilation is recommended, the application of increased positive end-expiratory pressure (PEEP) has been associated with elevated intracranial pressure (ICP) due to altered cerebral venous...
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SpringerOpen
2024-12-01
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| Series: | Intensive Care Medicine Experimental |
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| Online Access: | https://doi.org/10.1186/s40635-024-00703-x |
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| author | Álmos Schranc John Daniels Roberta Südy Fabienne Fontao Philippe Bijlenga Guillaume Plourde Hervé Quintard |
| author_facet | Álmos Schranc John Daniels Roberta Südy Fabienne Fontao Philippe Bijlenga Guillaume Plourde Hervé Quintard |
| author_sort | Álmos Schranc |
| collection | DOAJ |
| description | Abstract Background Patients with brain damage often require mechanical ventilation. Although lung-protective ventilation is recommended, the application of increased positive end-expiratory pressure (PEEP) has been associated with elevated intracranial pressure (ICP) due to altered cerebral venous return. This study investigates the effects of flow-controlled ventilation (FCV) using negative end-expiratory pressures (NEEP), on cerebral hemodynamics in a swine model of intracranial hypertension. Methods A model of intracranial hypertension involving bilateral trepan bolt holes was performed in 14 pigs. Pressure-controlled volume-guaranteed ventilation (PCV-VG) with PEEP and FCV using PEEP and then NEEP were applied. Intracranial pressure and oxygenation, as well as systemic hemodynamics and gas exchange parameters, were continuously monitored. Data were collected at baseline and at varying PEEP levels for both PCV-VG and FCV ventilation modalities. Following this, FCV ventilation and NEEP levels of -3, -6 and -9 cmH2O were applied. Results ICP remained stable with low PEEP levels, but significantly decreased with NEEP. Lower ICP following NEEP improved cerebral perfusion pressure and cerebral tissue oxygenation (p < 0.05 for all). FCV with NEEP at EEP-6 and EEP-9 significantly improved cardiac output and mean arterial pressure (MAP), compared to PCV-VG and FCV using PEEP (p < 0.05, respectively). There were no significant differences in gas exchange parameters between modalities (PCV-VG vs FCV), and between the application of PEEP or NEEP. No significant correlations were observed between ΔICP and ΔMAP. Conclusion The application of FCV with NEEP appears to be a safe ventilation mode and offers an additional tool for controlling severe intracranial pressure episodes. These findings warrant validation in future studies and may lead to important potential applications in clinical practice. |
| format | Article |
| id | doaj-art-be514b6065fe41e580c46e60a642d611 |
| institution | OA Journals |
| issn | 2197-425X |
| language | English |
| publishDate | 2024-12-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Intensive Care Medicine Experimental |
| spelling | doaj-art-be514b6065fe41e580c46e60a642d6112025-08-20T01:56:23ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2024-12-011211810.1186/s40635-024-00703-xSafety of flow-controlled ventilation with positive and negative end-expiratory pressure in a swine model of intracranial hypertensionÁlmos Schranc0John Daniels1Roberta Südy2Fabienne Fontao3Philippe Bijlenga4Guillaume Plourde5Hervé Quintard6Unit for Anaesthesiological Investigation, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University of GenevaUnit for Anaesthesiological Investigation, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University of GenevaUnit for Anaesthesiological Investigation, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University of GenevaUnit for Anaesthesiological Investigation, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University of GenevaDivision of Neurosurgery, Department of Clinical Neurosciences, Geneva University HospitalsDivision of Intensive Care Medicine, Department of Medicine, Centre Hospitalier de l’Université de MontréalDivision of Intensive Care, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University HospitalsAbstract Background Patients with brain damage often require mechanical ventilation. Although lung-protective ventilation is recommended, the application of increased positive end-expiratory pressure (PEEP) has been associated with elevated intracranial pressure (ICP) due to altered cerebral venous return. This study investigates the effects of flow-controlled ventilation (FCV) using negative end-expiratory pressures (NEEP), on cerebral hemodynamics in a swine model of intracranial hypertension. Methods A model of intracranial hypertension involving bilateral trepan bolt holes was performed in 14 pigs. Pressure-controlled volume-guaranteed ventilation (PCV-VG) with PEEP and FCV using PEEP and then NEEP were applied. Intracranial pressure and oxygenation, as well as systemic hemodynamics and gas exchange parameters, were continuously monitored. Data were collected at baseline and at varying PEEP levels for both PCV-VG and FCV ventilation modalities. Following this, FCV ventilation and NEEP levels of -3, -6 and -9 cmH2O were applied. Results ICP remained stable with low PEEP levels, but significantly decreased with NEEP. Lower ICP following NEEP improved cerebral perfusion pressure and cerebral tissue oxygenation (p < 0.05 for all). FCV with NEEP at EEP-6 and EEP-9 significantly improved cardiac output and mean arterial pressure (MAP), compared to PCV-VG and FCV using PEEP (p < 0.05, respectively). There were no significant differences in gas exchange parameters between modalities (PCV-VG vs FCV), and between the application of PEEP or NEEP. No significant correlations were observed between ΔICP and ΔMAP. Conclusion The application of FCV with NEEP appears to be a safe ventilation mode and offers an additional tool for controlling severe intracranial pressure episodes. These findings warrant validation in future studies and may lead to important potential applications in clinical practice.https://doi.org/10.1186/s40635-024-00703-xFlow-controlled ventilationPositive end-expiratory pressureNegative end-expiratory pressureCerebral hemodynamicsIntracranial hypertensionMechanical ventilation |
| spellingShingle | Álmos Schranc John Daniels Roberta Südy Fabienne Fontao Philippe Bijlenga Guillaume Plourde Hervé Quintard Safety of flow-controlled ventilation with positive and negative end-expiratory pressure in a swine model of intracranial hypertension Intensive Care Medicine Experimental Flow-controlled ventilation Positive end-expiratory pressure Negative end-expiratory pressure Cerebral hemodynamics Intracranial hypertension Mechanical ventilation |
| title | Safety of flow-controlled ventilation with positive and negative end-expiratory pressure in a swine model of intracranial hypertension |
| title_full | Safety of flow-controlled ventilation with positive and negative end-expiratory pressure in a swine model of intracranial hypertension |
| title_fullStr | Safety of flow-controlled ventilation with positive and negative end-expiratory pressure in a swine model of intracranial hypertension |
| title_full_unstemmed | Safety of flow-controlled ventilation with positive and negative end-expiratory pressure in a swine model of intracranial hypertension |
| title_short | Safety of flow-controlled ventilation with positive and negative end-expiratory pressure in a swine model of intracranial hypertension |
| title_sort | safety of flow controlled ventilation with positive and negative end expiratory pressure in a swine model of intracranial hypertension |
| topic | Flow-controlled ventilation Positive end-expiratory pressure Negative end-expiratory pressure Cerebral hemodynamics Intracranial hypertension Mechanical ventilation |
| url | https://doi.org/10.1186/s40635-024-00703-x |
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