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Intracranial-to-Central Venous Pressure Gap Predicts the Responsiveness of Intracranial Pressure to PEEP in Patients with Traumatic Brain Injury: a Prospective Cohort Study
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, the individual responsiveness of intracranial pressure (ICP) to PEEP varies. Thus, identifying an indicator detecting ICP responsiveness to PEEP is of great significance. As central venous pressure (CVP) could act as an intermediary to transduce pressure from PEEP to ICP, we developed a new indicator, PICGap, representing the gap between baseline ICP and baseline CVP. The aim of the current study was to explore the relationship between PICGap and ICP responsiveness to PEEP.
Methods: A total of 112 patients with sTBI undergoing MV were enrolled in this prospective cohort study. ICP, CVP, cerebral perfusion pressure (CPP), static compliance of the respiratory system (Cst), and end-tidal carbon dioxide pressure (PetCO2) were recorded at the initial (3 cmH2O) and adjusted (15 cmH2O) levels of PEEP. PICGap was assessed as baseline ICP - baseline CVP (when PEEP=3 cmH2O). The patients were classified into the ICP responder and non-responder groups based on whether ICP increment with PEEP adjusted from 3 cmH2O to 15 cmH2O was greater than 20% of baseline ICP. The above parameters were compared between the two groups, and prediction of ICP responsiveness to PEEP adjustment was evaluated by receiver operating characteristic (ROC) curve analysis.
Results: Compared with the non-responder group, the responder group had lower PICGap (1.63±1.33 versus 6.56±2.46 mmHg; p<0.001), lower baseline ICP, and higher baseline CVP. ROC curve analysis suggested that PICGap was a stronger predictive indicator of ICP responsiveness to PEEP (AUC=0.957, 95%CI 0.918-0.996; p<0.001) compared with baseline ICP and baseline CVP, with favorable sensitivity (95.24%, 95%CI 86.91%-98.70%) and specificity (87.6%, 95%CI 75.76%-94.27%), at a cut off value of 2.5 mmHg.
Conclusion: The impact of PEEP on ICP depends on the gap between baseline ICP and baseline CVP, i.e. PICGap. In addition, PICGap is a potential predictor of 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: Under Review
Version 2
Posted 12 May, 2020
No community comments so far
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
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
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PDF Downloads: ...
HTML Views: ...
Subject Areas
Neurology
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This preprint is under consideration at BMC Neurology. A preprint is 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
Intracranial-to-Central Venous Pressure Gap Predicts the Responsiveness of Intracranial Pressure to PEEP in Patients with Traumatic Brain Injury: a Prospective Cohort Study
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: Under Review
Version 2
Posted 12 May, 2020
No community comments so far
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
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
Background: Mechanical ventilation (MV) with positive end-expiratory pressure (PEEP) is commonly applied in patients with severe traumatic brain injury (sTBI). However, the individual responsiveness of intracranial pressure (ICP) to PEEP varies. Thus, identifying an indicator detecting ICP responsiveness to PEEP is of great significance. As central venous pressure (CVP) could act as an intermediary to transduce pressure from PEEP to ICP, we developed a new indicator, PICGap, representing the gap between baseline ICP and baseline CVP. The aim of the current study was to explore the relationship between PICGap and ICP responsiveness to PEEP.
Methods: A total of 112 patients with sTBI undergoing MV were enrolled in this prospective cohort study. ICP, CVP, cerebral perfusion pressure (CPP), static compliance of the respiratory system (Cst), and end-tidal carbon dioxide pressure (PetCO2) were recorded at the initial (3 cmH2O) and adjusted (15 cmH2O) levels of PEEP. PICGap was assessed as baseline ICP - baseline CVP (when PEEP=3 cmH2O). The patients were classified into the ICP responder and non-responder groups based on whether ICP increment with PEEP adjusted from 3 cmH2O to 15 cmH2O was greater than 20% of baseline ICP. The above parameters were compared between the two groups, and prediction of ICP responsiveness to PEEP adjustment was evaluated by receiver operating characteristic (ROC) curve analysis.
Results: Compared with the non-responder group, the responder group had lower PICGap (1.63±1.33 versus 6.56±2.46 mmHg; p<0.001), lower baseline ICP, and higher baseline CVP. ROC curve analysis suggested that PICGap was a stronger predictive indicator of ICP responsiveness to PEEP (AUC=0.957, 95%CI 0.918-0.996; p<0.001) compared with baseline ICP and baseline CVP, with favorable sensitivity (95.24%, 95%CI 86.91%-98.70%) and specificity (87.6%, 95%CI 75.76%-94.27%), at a cut off value of 2.5 mmHg.
Conclusion: The impact of PEEP on ICP depends on the gap between baseline ICP and baseline CVP, i.e. PICGap. In addition, PICGap is a potential predictor of ICP responsiveness to PEEP adjustment in patients with sTBI.
Figure 1
Figure 2
Figure 3