Abstract:The impact of positive end-expiratory pressure on cerebral perfusion pressure in adult patients with hemorrhagic stroke Repercussão da pressão positiva expiratória final na pressão de perfusão cerebral em pacientes adultos com acidente vascular hemorrágico
“…Therefore, IMV can have hemodynamic repercussions, leading to increases in ICP and reductions in CPP because compression of the alveolar capillaries, which is caused by distention of the alveoli, can lead to increased right ventricle afterload, thus reducing venous return. ( 28 )…”
ObjectiveTo analyze the outcomes of increased or decreased intracranial pressure and/or the
decrease in cerebral perfusion pressure resulting from respiratory physiotherapy
on critically ill patients admitted to the intensive care unit.MethodsThrough a systematic review of the literature, clinical trials published between
2002 and 2012 were selected. The search involved the LILACS, SciELO, MedLine and
PEDro databases using the keywords "physical therapy", "physiotherapy",
"respiratory therapy" and "randomized controlled trials" combined with the keyword
"intracranial pressure".ResultsIn total, five studies, including a total of 164 patients between 25 and 65 years
of age, reporting that respiratory physiotherapy maneuvers significantly increased
intracranial pressure without changing the cerebral perfusion pressure were
included. The articles addressed several techniques including vibration,
vibrocompression, tapping, postural drainage, and the endotracheal aspiration
maneuver. All patients required invasive mechanical ventilation.ConclusionRespiratory physiotherapy leads to increased intracranial pressure. Studies
suggest that there are no short-term hemodynamic or respiratory repercussions or
changes in the cerebral perfusion pressure. However, none of the studies evaluated
the clinical outcomes or ensured the safety of the maneuvers.
“…Therefore, IMV can have hemodynamic repercussions, leading to increases in ICP and reductions in CPP because compression of the alveolar capillaries, which is caused by distention of the alveoli, can lead to increased right ventricle afterload, thus reducing venous return. ( 28 )…”
ObjectiveTo analyze the outcomes of increased or decreased intracranial pressure and/or the
decrease in cerebral perfusion pressure resulting from respiratory physiotherapy
on critically ill patients admitted to the intensive care unit.MethodsThrough a systematic review of the literature, clinical trials published between
2002 and 2012 were selected. The search involved the LILACS, SciELO, MedLine and
PEDro databases using the keywords "physical therapy", "physiotherapy",
"respiratory therapy" and "randomized controlled trials" combined with the keyword
"intracranial pressure".ResultsIn total, five studies, including a total of 164 patients between 25 and 65 years
of age, reporting that respiratory physiotherapy maneuvers significantly increased
intracranial pressure without changing the cerebral perfusion pressure were
included. The articles addressed several techniques including vibration,
vibrocompression, tapping, postural drainage, and the endotracheal aspiration
maneuver. All patients required invasive mechanical ventilation.ConclusionRespiratory physiotherapy leads to increased intracranial pressure. Studies
suggest that there are no short-term hemodynamic or respiratory repercussions or
changes in the cerebral perfusion pressure. However, none of the studies evaluated
the clinical outcomes or ensured the safety of the maneuvers.
“…Nesse sentido, acredita-se que a complacência do sistema respiratório é um dos fatores determinantes na transmissão da PEEP para o compartimento intracraniano, de forma que pacientes com baixa complacência pulmonar podem tolerar valores de PEEP até 12cmH2O sem que haja comprometimento da hemodinâmica cerebral 6 . Sendo assim, tende-se a acreditar que o emprego de PEEPs em níveis baixos a moderados é uma medida que melhora a troca gasosa alveolar e a oxigenação tecidual sem causar efeitos deletérios no compartimento intracraniano por aumento da PIC 6,14 .…”
Section: Metodologiaunclassified
“…Herpes (HSV-1) 49, 50 HIV 1,2,13,14,49,50,51,52,56,57,58,59,120 Humor 93,94,96,97,99,100,101,103,104,105 I Infecção 12,20,26,27,30,31,35,39,42,47,49,50,51,52,54,55,56,57,58,60,61,62,63,64,65,67,68,74,96,110,116,118,119,122,137,149,174,177,178,…”
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“…Os ventiladores da UTI oferecem o mais alto desempenho, mecanismos de resposta rápida e muitas vezes vários modos ventilatórios diferentes com melhor adaptação à condição de cada paciente15 . No início da pandemia, todos os pacientes diagnosticados com Covid-19 grave eram considerados também portadores de SDRA e, visando minimizar as lesões induzidas pela ventilação (VILI), esses eram ventilados com baixos volumes correntes (VC) -6 mL/ kg7,14 . Atualmente, The Surviving Sepsis Campaign Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2020 recomendam o uso da VM com baixo volume corrente (4 -8 mL/Kg) e utilização de PEEP (pressão expiratória final positiva) mais altas (>10 cmH2O).…”
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