RESUMO
BACKGROUND: Severe traumatic brain injury (TBI) results in raised intracranial pressure (ICP). Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) is a noninvasive method for the assessment of raised ICP. Manipulation of positive end-expiratory pressure (PEEP) and end-tidal carbon dioxide (ETCO2) are often used to optimize ICP and improve oxygenation in TBI patients. This study evaluated the effects of PEEP and ETCO2 on ONSD and regional cerebral oxygen saturation (rScO2) in patients with acute TBI. METHODS: A total of 14 patients (11 males) aged older than 18 years with acute severe TBI were included in this study. ONSD and rScO2 were assessed before and after changes in PEEP from 5 to 10 cm H2O and in ETCO2 from 40 to 30 mm Hg on both pathologic and nonpathologic sides. RESULTS: Increasing PEEP and reducing ETCO2 resulted in changes in ONSD and rScO2 on both pathologic and nonpathologic sides. On the pathologic side, ONSD and rScO2 were highest with a PEEP of 10 cm H2O:ETCO2 40 mm Hg combination and lowest with PEEP of 5 cm H2O:ETCO2 30 mm Hg (ONSD 5.24±0.49 vs. 4.27±0.36 mm, P<0.001; rScO2 70.7±9.91% vs. 66.3±9.75%, P<0.001); both PEEP and ETCO2 had significant effects on ONSD and rScO2 (P<0.001). On the nonpathologic side, ONSD and rScO2 were highest and lowest with PEEP of 10 cm H2O:ETCO2 40 mm Hg and PEEP of 5 cm H2O:ETCO2 30 mm Hg combinations, respectively (ONSD: 4.93±0.46 vs. 4.02±0.40 mm, P<0.001; rScO2: 74.77±8.30% vs. 70.69±8.12%, P<0.001). ETCO2 had a significant effect on rScO2 (P<0.001), but the impact of PEEP on rScO2 was not statistically significant (P=0.05). CONCLUSION: Increasing PEEP resulted in significant increases in ONSD and rScO2, whereas reducing ETCO2 significantly decreased ONSD and rScO2.