Intracranial Pressure During Pressure Control and Pressure-Regulated Volume Control Ventilation in Patients with Traumatic Brain Injury: A Randomized Crossover trial

• Published in: Neurocritical care 2016-06, Vol.24 (3), p.332-341
• Main Authors: Schirmer-Mikalsen, Kari, Vik, Anne, Skogvoll, Eirik, Moen, Kent Gøran, Solheim, Ole, Klepstad, Pål
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia; Blood pressure; Brain Injuries, Traumatic - diagnosis; Brain Injuries, Traumatic - physiopathology; Brain Injuries, Traumatic - therapy; Cerebrospinal fluid; Critical Care - methods; Critical Care Medicine; Cross-Over Studies; Female; Hemoglobin; Humans; Hyperventilation; Hypothermia; Intensive; Internal Medicine; Intracranial pressure; Intracranial Pressure - physiology; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neurology; Original Article; Outcome and Process Assessment (Health Care); Oxygen saturation; Patients; Physiology; Positive-Pressure Respiration - methods; Respiration, Artificial - methods; Tidal Volume - physiology; Traumatic brain injury; Ventilators; Young Adult
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-015-0208-8

Introduction Mechanical ventilation with control of partial arterial CO 2 pressures (PaCO 2 ) is used to treat or stabilize intracranial pressure (ICP) in patients with traumatic brain injury (TBI). Pressure-regulated volume control (PRVC) is a ventilator mode where inspiratory pressures are automatically adjusted to deliver the patient a pre-set stable tidal volume (TV). This may result in a more stable PaCO 2 and thus a more stable ICP compared with conventional pressure control (PC) ventilation. The aim of this study was to compare PC and PRVC ventilation in TBI patients with respect to ICP and PaCO 2 . Methods This is a randomized crossover trial including eleven patients with a moderate or severe TBI who were mechanically ventilated and had ICP monitoring. Each patient was administered alternating 2-h periods of PC and PRVC ventilation. The outcome variables were ICP and PaCO 2 . Results Fifty-two (26 PC, 26 PRVC) study periods were included. Mean ICP was 10.8 mmHg with PC and 10.3 mmHg with PRVC ventilation ( p  = 0.38). Mean PaCO 2 was 36.5 mmHg (4.87 kPa) with PC and 36.1 mmHg (4.81 kPa) with PRVC ( p  = 0.38). There were less fluctuations in ICP ( p  = 0.02) and PaCO 2 ( p  = 0.05) with PRVC ventilation. Conclusions Mean ICP and PaCO 2 were similar for PC and PRVC ventilation in TBI patients, but PRVC ventilation resulted in less fluctuation in both ICP and PaCO 2 . We cannot exclude that the two ventilatory modes would have impact on ICP in patients with higher ICP values; however, the similar PaCO 2 observations argue against this.