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Research article
Li Qing Yun
Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
Corresponding Author
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Background: Mechanical ventilation (MV) with positive end-expiratory pressure (PEEP) is commonly applied in patients with severe traumatic brain injury (sTBI). However, non-indicators to predict the influence of PEEP on intracranial pressure (ICP) prevent the optimal use of PEEP. As the central venous pressure (CVP) could act as an intermediary to transduce the pressure from PEEP to ICP, we set up a new indicators PICGap (representing the gap between the baseline ICP and baseline CVP). The aim of the study was to explore the relationship between PICGap and the ICP responsiveness to PEEP. Methods: Total 112 patients with sTBI undergoing MV were finally enrolled. ICP, CVP, cerebral perfusion pressure (CPP), static compliance of respiratory system (Cst), and end-tidal carbon dioxide pressure (PetCO2) were recorded at initial level of PEEP (3 cmH2O) and adjusted levels of PEEP (15 cmH2O). PICGap was calculated by baseline ICP - baseline CVP (when PEEP=3 cmH2O). The patients enrolled were classified into either an ICP responder group or a non-responder group based on whether the increment of ICP when PEEP adjustment from 3 cmH2O to 15 cmH2O was greater than or less than 20% of baseline ICP. Parameters recorded above were compared between two groups and the prediction of ICP responsiveness to PEEP adjustment were evaluated by receiver operating characteristic (ROC). Results: Responder group had lower PICGap, lower baseline ICP, and higher baseline CVP compared with non-responder group. ROC analysis suggested that PICGap could act as a strongest predictive indicator for the ICP responsiveness to PEEP (AUC = 0.957, 95% CI: 0.918 - 0.996, p <0.001) compared with baseline ICP and baseline CVP, with a favorable sensitivity of 95.24% (95% CI: 86.91% - 98.70%) and specificity of 87.6% (95% CI: 75.76% - 94.27%) when the cut off value of 2.5mmHg was determined. Conclusion: The impact of PEEP on ICP depends on the GAP of between baseline ICP and baseline CVP, i.e. PICGap. The PICGap could be a potential predictor for ICP responsiveness to PEEP adjustment in patients with sTBI.
Keywords
Positive end-expiratory pressure; intracranial pressure; central venous pressure; mechanical ventilation; traumatic brain injury; PICGap
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CURRENT STATUS: Published
View the published article at BMC Neurology.
No community comments so far
Editorial decision: Accept
On 04 May, 2020
Review #1 received
Received 30 Apr, 2020
Reviewers invited
Invitations sent on 29 Apr, 2020
Reviewer #1 agreed
On 29 Apr, 2020
Editor assigned
On 28 Apr, 2020
Editor invited
On 27 Apr, 2020
Submission checks complete
On 28 Nov, 2019
Version 1
Posted 02 Dec, 2019
Community comments: 1
Editorial decision: Major revision
On 25 Mar, 2020
Review #2 received
Received 23 Mar, 2020
Reviewer #2 agreed
On 11 Mar, 2020
Reviewer #1 agreed
On 02 Jan, 2020
Review #1 received
Received 02 Jan, 2020
Reviewers invited
Invitations sent on 16 Dec, 2019
Editor invited
On 28 Nov, 2019
Editor assigned
On 15 Nov, 2019
First submitted
On 14 Nov, 2019
Submission checks complete
On 14 Nov, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Neurology
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A new preprint design is coming!
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See the published version of this preprint at BMC Neurology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Li Qing Yun
Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Neurology.
No community comments so far
Editorial decision: Accept
On 04 May, 2020
Review #1 received
Received 30 Apr, 2020
Reviewers invited
Invitations sent on 29 Apr, 2020
Reviewer #1 agreed
On 29 Apr, 2020
Editor assigned
On 28 Apr, 2020
Editor invited
On 27 Apr, 2020
Submission checks complete
On 28 Nov, 2019
Version 1
Posted 02 Dec, 2019
Community comments: 1
Editorial decision: Major revision
On 25 Mar, 2020
Review #2 received
Received 23 Mar, 2020
Reviewer #2 agreed
On 11 Mar, 2020
Reviewer #1 agreed
On 02 Jan, 2020
Review #1 received
Received 02 Jan, 2020
Reviewers invited
Invitations sent on 16 Dec, 2019
Editor invited
On 28 Nov, 2019
Editor assigned
On 15 Nov, 2019
First submitted
On 14 Nov, 2019
Submission checks complete
On 14 Nov, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Neurology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Neurology.
Background: Mechanical ventilation (MV) with positive end-expiratory pressure (PEEP) is commonly applied in patients with severe traumatic brain injury (sTBI). However, non-indicators to predict the influence of PEEP on intracranial pressure (ICP) prevent the optimal use of PEEP. As the central venous pressure (CVP) could act as an intermediary to transduce the pressure from PEEP to ICP, we set up a new indicators PICGap (representing the gap between the baseline ICP and baseline CVP). The aim of the study was to explore the relationship between PICGap and the ICP responsiveness to PEEP. Methods: Total 112 patients with sTBI undergoing MV were finally enrolled. ICP, CVP, cerebral perfusion pressure (CPP), static compliance of respiratory system (Cst), and end-tidal carbon dioxide pressure (PetCO2) were recorded at initial level of PEEP (3 cmH2O) and adjusted levels of PEEP (15 cmH2O). PICGap was calculated by baseline ICP - baseline CVP (when PEEP=3 cmH2O). The patients enrolled were classified into either an ICP responder group or a non-responder group based on whether the increment of ICP when PEEP adjustment from 3 cmH2O to 15 cmH2O was greater than or less than 20% of baseline ICP. Parameters recorded above were compared between two groups and the prediction of ICP responsiveness to PEEP adjustment were evaluated by receiver operating characteristic (ROC). Results: Responder group had lower PICGap, lower baseline ICP, and higher baseline CVP compared with non-responder group. ROC analysis suggested that PICGap could act as a strongest predictive indicator for the ICP responsiveness to PEEP (AUC = 0.957, 95% CI: 0.918 - 0.996, p <0.001) compared with baseline ICP and baseline CVP, with a favorable sensitivity of 95.24% (95% CI: 86.91% - 98.70%) and specificity of 87.6% (95% CI: 75.76% - 94.27%) when the cut off value of 2.5mmHg was determined. Conclusion: The impact of PEEP on ICP depends on the GAP of between baseline ICP and baseline CVP, i.e. PICGap. The PICGap could be a potential predictor for ICP responsiveness to PEEP adjustment in patients with sTBI.
Figure 1
Figure 2
Figure 3
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