Positive and Expiratory Pressure and Hemorrhagic Stroke
Condition: Stroke; Hemorrhage
MeSH terms: Stroke; Hemorrhagic Stroke; Hemorrhage
Study type: Interventional

Summary: 
      Intrathoracic positive pressure may lead to a change hemodynamics, with repercussions for the
      intracranial compartment, thereby altering intracranial pressure (ICP) and cerebral perfusion
      pressure (CPP). This effect may become more intense when using high positive end expiratory
      pressure (PEEP) values. The aim of the present study was to measure the impact of different
      PEEP values on ICP, CPP and mean arterial pressure (MAP). MAP, whereas high PEEP values
      increase ICP, although without clinical relevance.
    

Detailed description: 
      This study is a prospective clinical trial, developed in the neurological intensive care unit
      approved by the ethics committee and research in humans. The charge of each patient had
      information about the study through the completion of informed consent and signed him when he
      agreed. Were the following inclusion criteria: adult patients with acute CVA and presence of
      ventricular drainage catheter for invasive monitoring of ICP and without intracranial
      hypertension. Were adopted as exclusion criteria: increased intracranial pressure,
      hemodynamic instability as a criterion of loss was used to expressions of interest in charge
      to leave. All patients completed the study. <br>All patients were from the surgical
      implantation of the ventricular catheter, arriving to the ICU intubated orally and manually
      ventilated with an Ambu bag. Were subjected to routine procedures: adjusting the mechanical
      ventilator (Inter5, Intermed, BR) during assisted controlled cycled pressure and facility to
      monitor vital signs. After thirty minutes of stable ICU patient in a supine position with
      head elevated 30 °, the protocol was initiated to assess the impact of PEEP on ICP. To
      perform the evaluation of lung mechanics ventilatory mode was changed to control volume with
      the following parameters: tidal volume (Vt) = 8ml/kg weight, peak flow (PF) = 6 x minute
      volume, fraction of inspired O2 (FiO2) = 40%, respiratory rate (RR) = 16 bpm, sensitivity = 1
      cmH2O. The following variables were monitored: PIC, Blood Pressure (BP), heart rate (HR),
      peak pressure in the airways (pp.) and plateau pressure of the respiratory system (Ppl.),
      these values were monitored with PEEP = 5 cmH2O. <br>During the assessment protocol was
      changed to pressure control ventilation mode with the following values of ventilatory
      parameters: Pp = 30 cm H2O, inspiratory time = 1s; FiO2 = 40%, RR = 16 bpm; Sensitivity = 1
      cmH2O. PEEP employed ranged from 0 to 14 cmH2O. To eliminate a possible physiological
      accommodation by the progressive increase of PEEP, the range of values was determined by
      drawing a sealed envelope for each patient, ranging from 2 to 2 cmH2O. At each value of PEEP
      the patient was ventilated for a period of five minutes to carry out monitoring of ICP, BP,
      HR, PPC and peripheral oxygen saturation (SpO2). The ICP monitoring catheter was kept closed
      for drainage and open for monitoring, since the arrival of the surgical block, was only open
      for drainage if there was an increase in ICP above 20 mmHg. <br>The monitoring was carried
      out using the multiparameter monitor (Siemens 7000). For ICP monitoring the ventricular
      catheter was connected to a pressure transducer and this monitor. <br>After the parameters
      evaluated with seven different PEEP values, the ventilatory mode was changed again to control
      volume again to evaluate pulmonary mechanics with the same initial parameters.
    

Intervention name(s): lung mechanics ventilatory; Hemodynamic and intracranial pressure
Intervention type(s): Other; Other
Intervention description(s): To perform the evaluation of lung mechanics ventilatory mode was changed to control volume with the following parameters: tidal volume (Vt) = 8ml/kg weight, peak flow (PF) = 6 x minute volume, fraction of inspired O2 (FiO2) = 40%, respiratory rate (RR) = 16 bpm, sensitivity = 1 cmH2O. The following variables were monitored: PIC, Blood Pressure (BP), heart rate (HR), peak pressure in the airways (pp.) and plateau pressure of the respiratory system (Ppl.), these values were monitored with PEEP = 5 cmH2O. PEEP employed ranged from 0 to 14 cmH2O. To eliminate a possible physiological accommodation by the progressive increase of PEEP, the range of values was determined by drawing a sealed envelope for each patient, ranging from 2 to 2 cmH2O.; At each value of PEEP the patient was ventilated for a period of five minutes to carry out monitoring of ICP, BP, HR, PPC and peripheral oxygen saturation (SpO2). The ICP monitoring catheter was kept closed for drainage and open for monitoring, since the arrival of the surgical block, was only open for drainage if there was an increase in ICP above 20 mmHg.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: PEEP; Patients with hemorrhage stroke under mechanical ventilation