ArticleIntensive care medicine experimental2025
Intracranial response to positive end-expiratory pressure is influenced by lung recruitability and gas distribution during mechanical ventilation in acute brain injury patients: a proof-of-concept physiological study.
Article in Intensive care medicine experimental, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05363085 (The Effects of Airway Closure, Expiratory Flow Limitation and of a Passive Chest Wall on the Onset of an Uncontrolled Expiration and on Intracranial Pressure. An Observational Clinical Study on Neurosurgical Patients.), which is not on this map. Cited by 5 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Effects of Airway Closure, Expiratory Flow Limitation and of a Passive Chest Wall on the Onset of an Uncontrolled Expiration and on Intracranial Pressure. An Observational Clinical Study on Neurosurgical Patients. (The CeRes-CMV Study)
Who cites it
5 citing papers in PubMed.
- Ventilator-Induced Signal Interference and the Accuracy of the Pressure Reactivity Index in Acute Brain Injury.Neurocritical care · 2026Article
- Temporal Dynamics of Cerebral Autoregulation after Aneurysmal Subarachnoid Hemorrhage: Insights from Pressure Reactivity Index and Non-injured Controls.Neurology and therapy · 2026Article
- Positive end-expiratory pressure increases intracranial pressure but does not affect PRx, regardless of body position, in a porcine ARDS model.Frontiers in physiology · 2026Article
- First Breath Matters: Out-of-Hospital Mechanical Ventilation in Patients with Traumatic Brain Injury.Journal of clinical medicine · 2025Review
- Pathophysiology and clinical applications of PEEP in acute brain injury.Intensive care medicine · 2025Review
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Authors and funding
13 authors.
Funding
Abstract
backgroundThe effect of positive end-expiratory pressure (PEEP) on intracranial pressure (ICP) dynamics in patients with acute brain injury (ABI) remains controversial. PEEP can benefit oxygenation by promoting alveolar recruitment, but its influence on ICP is complex. The primary aims of this study were to investigate 1) how lung recruitability influences oxygenation and 2) how lung recruitability and regional gas distribution, measured via recruitment-to-inflation (RI) ratio and electrical impedance tomography (EIT), affect ICP in response to PEEP changes in critically ill patients in their early phase of ABI.
methodsTen mechanically ventilated ABI patients were included. Pressure reactivity index (PRx) was estimated. Using RI manoeuvre and EIT, lung recruitability and gas distribution were assessed in response to a standardised PEEP change (from high to low levels, with a delta of 10 cmH
resultsBlood oxygenation significantly decreased, going from high (14 [IQR: 12-15] cmH₂O) to low (4 [IQR: 2-5] cmH₂O) PEEP. Reducing PEEP significantly increased ICP (from 9 [IQR: 5-13] to 12 [IQR: 8-16] mmHg, p < 0.01), while cerebral perfusion pressure (CPP) improved (from 71 [IQR:67-83] to 75 [IQR: 70-84] mmHg, p = 0.03) and mean arterial pressure (MAP) increased (from 79 [IQR: 69-95] to 84 [IQR: 76-99] mmHg, p < 0.01). The RI ratio correlated significantly with ΔICP (rho = 0.87, p < 0.01), as did Vrec% (proportion of recruited volume, rho = 0.65) and GI (rho = 0.5). LI did not correlate with ΔICP. PRx was 0.30 [IQR: 0.12-0.42], indicating a deranged cerebral autoregulation.
conclusionsPatients with a higher potential for lung recruitability had a more beneficial effect of PEEP on oxygenation. These effects should be interpreted cautiously, given that lung recruitability and global inhomogeneity of gas distribution significantly influenced the intracranial response to PEEP in ABI patients. As indicated by MAP and CPP, PEEP may impact systemic haemodynamics and cerebral perfusion when cerebral autoregulation is deranged. These findings underscore the importance of multimodal (i.e. respiratory, cerebral and haemodynamics) monitoring for optimising ventilation strategies in ABI patients and provide a framework for future research. Trial registration Registration number: NCT05363085, Date of registration: May 2022.
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