| Title: |
Positive end-expiratory pressure increases intracranial pressure but not pressure reactivity index in supine and prone positions: a porcine model study |
| Authors: |
Rønnaug Hammervold, Erta Beqiri, Peter Smielewski, Benjamin S. Storm, Erik W. Nielsen, Claude Guérin, Shirin K. Frisvold |
| Source: |
Frontiers in Medicine, Vol 11 (2025) |
| Publisher Information: |
Frontiers Media S.A., 2025. |
| Publication Year: |
2025 |
| Collection: |
LCC:Medicine (General) |
| Subject Terms: |
cerebral autoregulation, ICP, neurocritical care, neuromonitoring, pulmonary issues, ventilation, Medicine (General), R5-920 |
| More Details: |
IntroductionPositive end-expiratory pressure (PEEP) and prone positioning can improve gas exchange by promoting uniform lung aeration. However, elevated ventilation pressures may increase intracranial pressure (ICP) and disrupt cerebral autoregulation. This study investigated the effects of PEEP on ICP and cerebral autoregulation in a porcine model with healthy lungs and normal ICP, comparing prone and supine positions. Cerebral autoregulation was assessed through cerebrovascular reactivity using the pressure reactivity index (PRx). We also explored whether other baseline variables influenced potential variances in ICP and PRx.MethodologyTwelve anesthetized pigs were randomized to begin in either supine or prone position, across PEEP of 5, 10, 15, and 20 cmH2O. Continuous monitoring included esophageal pressure to calculate end-inspiratory and end-expiratory transpulmonary pressures. The ICM+® software (University of Cambridge Enterprise, Cambridge, United Kingdom) was used for high-resolution data collection, signal processing and ICP curve analysis. Linear mixed-effects models and ANOVA were used to analyze changes in ICP and PRx and the influence of position. An exploratory correlation analysis was conducted on baseline variables potentially related to the ICP increase.ResultsMean ICP increase was 1.0 mmHg ± 0.9 at 10 cmH2O PEEP, 2.0 mmHg ± 1.7 at 15 cmH2O PEEP, and 3.1 mmHg ± 1.6 at 20 cmH2O PEEP compared to a baseline PEEP of 5 cmH2O (p |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
2296-858X |
| Relation: |
https://www.frontiersin.org/articles/10.3389/fmed.2024.1501284/full; https://doaj.org/toc/2296-858X |
| DOI: |
10.3389/fmed.2024.1501284 |
| Access URL: |
https://doaj.org/article/3abca6b3c6ee4ea0863ad7643b4f4174 |
| Accession Number: |
edsdoj.3abca6b3c6ee4ea0863ad7643b4f4174 |
| Database: |
Directory of Open Access Journals |
