New England Surgical Society (NESS)
Search NESS
  Annual Meeting
  Annual Resident and Fellow Research Day
      Member Directory
      Members Only
  Scholars Foundation
  Job Board
  Journal of the American College of Surgeons
  Contact NESS

90th Annual Meeting Abstracts

The Effect of Positive End Expiratory Pressure on Traumatic Brain Injury
Suresh Agarwal, MD, *Karl Pilson, MD, *Patrick Kinnaird, BA, Peter Burke, MD
Boston University School of Medicine, Boston, MA

Objective: To determine PEEP's impact on patients with traumatic brain injury (TBI) who have an intra-cranial pressure (ICP) monitor in place.
Design: Five year retrospective review
Setting: Urban, Academic, Level I Trauma Center
Patients: TBI patients with Glasgow Coma Score (GCS) less than 9, ventilated, and monitored with an intra-cranial pressure monitor
Interventions: None
Main Outcome Measures:
ICP measurements recorded as a percentage of day (hours/day) when greater than 15 mm Hg and 20 mm Hg. Amount of PEEP utilized, mortality, ventilatory parameters, paralytic usage, vasopressor requirement, operative procedures and in-hospital morbidity.
Results: 70 patients met criteria, 51% received PEEP, 17.14% patients received NO PEEP, the remainder included patients in whom PEEP was started during the hospital course. ICP’s were noted to exceed 15 mm Hg 46.44% of the time on PEEP vs. 52.25% with NO PEEP. ICP’s exceeded 20 mm Hg 29.96% of the time with PEEP and 32% with NO PEEP. Cerebral perfusion pressure (CPP) dropped below 60 mm hg. 15.10% of the time with PEEP and 11.96% with NO PEEP. Pressor were required 21% of the time with NO PEEP and 38% of the time with PEEP. Injury severity scores were similar for the two groups: mean ISS of 23.12 (no PEEP) and 24.22 for PEEP; Mean AIS for TBI 8.73 for no PEEP and 8.08 for PEEP.
Conclusions: PEEP usage is safe in severe TBI patients who have ICP monitors. CPP Reductions and increased pressor requirement when using PEEP warrant further study in a randomized, prospective manner.


Copyright © 2020 New England Surgical Society. All Rights Reserved.
Read Privacy Policy.