Effect of Intrathoracic Pressure Regulation on Traumatic Brain Injury

Effects of Intrathoracic Pressure Regulation Therapy in Patients With Elevated Intracranial Pressure Due to Brain Injury or Intracranial Pathology

The purpose of this study is to demonstrate proof of clinical concept that application of the Intrathoracic Pressure Regulator (ITPR) will result in an increase in Cerebral Perfusion Pressure (CPP) and a decrease in Intracranial Perfusion Pressure (ICP) in patients with head injury and elevated ICP, and to determine the optimal ventilation tidal volume (TV).

Inclusion Criteria:

• ≥15 years of age
• intubated and mechanically ventilated on a volume controlled mode
• head injury or other intracranial pathology with ICP of ≥15 mmHg
• arterial line in place
• SpO2 ≥95%
• MAP >60
• in ICU or about to undergo neurosurgery with planned placement of an ICP monitor
• inclusion presents no significant delays to planned emergent neurosurgery
• prior written informed consent

Exclusion Criteria:

• cardiac or pulmonary injury impacting intrathoracic pressure
• confirmed pneumothorax or hemothorax
• PaO2/FiO2 <300
• serious neck injury resulting in neck swelling with jugular venous compression
• evidence of ongoing uncontrolled bleeding
• respiratory disease such as COPD, interstitial lung disease, or other parenchymal or pulmonary vascular disease
• congestive heart failure