Effects of lung protective ventilation on brain function in patients with traumatic brain injury / 中华急诊医学杂志

ABSTRACT

Objective:To evaluate the effect of individualized positive end-expiratory pressure (PEEP) ventilation strategy guided by driving pressure on intraoperative intracranial pressure in patients with moderate traumatic brain injury (TBI).Methods:Total of 111 patients aged 18-65 years old, with BMI of 17-28 kg/m 2, ASA grade of Ⅲ-Ⅳ, and Glasgow coma score of 9-11 before operation were treated with evacuation of intracranial hematoma in emergency. The patients were randomly divided into 0 cmH 2O PEEP group (Group 0 PEEP), 5 cmH 2O PEEP group (Group 5 PEEP) and individualized PEEP ventilation group (Group P) guided by driving pressure. The volume control ventilation mode is adopted, VT is 6 mL/kg, FiO 2 is 60%, and the inspiratory expiratory ratio is 1:2. Patients in Group 0 PEEP and Group 5 PEEP were given PEEP 0 or 5 cmH 2O for ventilation after tracheal intubation until the end of the operation. Patients in Group P were given individualized PEEP titration ventilation strategy guided by driving pressure after intubation. Blood gas analysis was performed at 5 min (T1) after tracheal intubation, 60 min (T3) after operation, and 5 min (T4) after operation. PaO 2, PaCO 2, and dynamic compliance (Cdyn) were recorded. The optic nerve sheath diameter (ONSD) was measured before anesthesia induction (T0), after PEEP titration in group P (T2, 10 min after ventilation in group 0 PEEP and 5 PEEP) and at T4; Serum neuron specific enolase (NSE) concentration was measured by ELISA before and 1 day and 3 days after operation; The occurrence of nervous system complications (intracranial infection, intracranial hypertension, epilepsy, brain edema, etc.) within 30 days after operation was followed up. Results:Compared with group 0 PEEP and 5 PEEP, Cdyn and PaO 2 in group P increased at T3-4 ( P<0.05), ONSD was not significantly different among the three groups ( P>0.05), NSE in group P decreased significantly at 1 and 3 days after operation, and the incidence of neurological complications in the three groups was not significantly different at 30 days after operation ( P>0.05). Conclusions:Individualized PEEP ventilation strategy guided by driving pressure can help improve lung and brain function in TBI patients.