Influence of inspiration:expiration ratio on intracranial and cerebral perfusion pressure in acute stroke patients.

Abstract:

OBJECTIVE:We undertook this study to evaluate the influence of the inspiration:expiration (I:E) ratio on intracranial pressure and cerebral perfusion in patients with acute stroke. DESIGN:Ventilated patients with acute stroke were examined under a protocol involving variations of I:E ratio from 1:2 to 1:1 to 1:2 under positive end-expiratory pressure (PEEP) of 5.3 and - subsequently - 10.6 cmH(2)O. Intracranial pressure was monitored with parenchymal or ventricular catheters. Mean arterial blood pressure, intracranial pressure (ICP), heart rate and peak mean flow velocity of the middle cerebral arteries were continuously recorded. SETTING:Neurological intensive care unit. PATIENTS:A total of 45 monitoring sessions were performed in 16 patients (subarachnoid haemorrhage 3, ischemic stroke 13). RESULTS:No significant changes in any of the parameters monitored were evident in association with the I:E ratio variations under either of the PEEP levels applied. It must be noted, though, that ICP exceeded 15 mmHg in only 5/45 monitoring sessions, and never exceeded 20 mmHg. CONCLUSIONS:Our preliminary results suggest that variations of the I:E ratio cause no significant changes in intracranial or cerebral perfusion pressure and, thus, can be safely used in patients with acute stroke without intracranial hypertension. The influence of I:E ratio variations on stroke patients with intracranial hypertension remains to be evaluated.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Georgiadis D,Schwarz S,Kollmar R,Baumgartner RW,Schwab S

doi

10.1007/s00134-002-1351-1

keywords:

subject

Has Abstract

pub_date

2002-08-01 00:00:00

pages

1089-93

issue

8

eissn

0342-4642

issn

1432-1238

journal_volume

28

pub_type

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