Mechanical Ventilation in Severe Brain Injury: The Effect of Positive End Expiratory Pressure on Intracranial Pressure

Mechanical Ventilation in Severe Brain Injury: The Effect of Positive End Expiratory Pressure on Intracranial Pressure

The purpose of this study is to collect physiologic data from patients with severe brain injury who require mechanical ventilation in order to describe the impact of ventilation, specifically positive end expiratory pressure (PEEP), on intracranial pressure (ICP).

Inclusion Criteria:

• Patients with severe brain injury (GCS 8 or less)
• Receiving mechanical ventilation
• Receiving intracranial pressure monitoring

Exclusion Criteria:

• Esophageal varices
• Esophageal trauma
• Recent esophageal surgery
• Coagulopathy (Platelets < 80k or INR> 2 )
• Other contraindication for esophageal manometry
• Already receiving PEEP > 15 cmH2O at enrollment
• Intracranial hypertension (defined as ICP > 20 mmHg)
• Decompressive hemi-craniectomy