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The impact of mechanical ventilation on intracranial perfusion is still not completely clarified. It is often assumed that raising airway pressure will invariably elevate the intracranial pressure, but this is not always the case.
The effects of airway pressure on intracranial pressure can depend on several factors, and among others, an uncontrolled expiration and consequent lung collapse may have an influence on cerebral perfusion.
This study will investigate the incidence and the consequences of an uncontrolled expiration and expiratory lung collapse in critically ill neurosurgical patients during controlled mechanical ventilation.
Electrical impedance tomography measurements , oesophagus and gastric pressure, electrical activity of the diaphragm and intracranial pressure will be acquired in a synchronised manner during controlled mechanical ventilation. Moreover, airway opening pressure, expiratory flow limitation and recruitment/inflation ratio will be determined during controlled mechanical ventilation, on a daily bases until the patient recover his/her own spontaneous breathing.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Mechanically ventilated neurosurgical patients | Observational study in mechanically ventilated neurosurgical patients |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Mechanically ventilated neurosurgical patients | Other | Observational study where respiratory variables and intracranial pressure will be measured during mechanical ventilation and during specific respiratory manoeuvres. No intervention is planned. |
| Measure | Description | Time Frame |
|---|---|---|
| The incidence of lung collapse | The incidence of an uncontrolled expiration and consequent expiratory lung collapse (determined by expiratory flow limitation, airway opening pressure and expiratory thoracic impedance) increased chest-wall elastance in neurosurgical patients. | during the period of controlled mechanical ventilation, an average of 14 days |
| Correlation between lung recruitability and intracerebral pressure | The influence of lung recruitability (determined by recruitment/inflation ratio and changes of thoracic impedance) on intra cerebral pressure in neurosurgical patients. | during the period of controlled mechanical ventilation, an average of 14 days |
| Correlation between lung collapse and intracerebral pressure | The correlation between an uncontrolled expiration (determined by expiratory flow limitation, airway opening and expiratory thoracic impedance), increased chest-wall elastance and intracranial pressure in neurosurgical patients. | during the period of controlled mechanical ventilation, an average of 14 days |
| Measure | Description | Time Frame |
|---|---|---|
| Intensive care unit (ICU) and hospital length of stay (LOS); | Correlation between lung collapse and LOS | At ICU/hospital discharge, an average of 30 days |
| Number of days of mechanical ventilation |
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The patients will be included within 48 hours from initiation of mechanical ventilation and insertion of an external ventricular drainage catheter
Inclusion Criteria:
Exclusion Criteria:
Relative contraindication: in case of skull base fracture the patient can be included only if oesophageal/gastric and NAVA catheters can be inserted orally.
Patients recruitment will be kept equally distributed between sexes.
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Critically ill adult patients affected by acute brain injury (e.g., subarachnoid hemorrhage, subdural hemorrhage, epidural hemorrhage, traumatic brain injury, intracerebral hemorrhage) admitted to the NICU of Uppsala. Consecutive patients will be prospectively screened for eligibility according to inclusion criteria
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mariangela Pellegrini, MD, PhD | Contact | +460186110000 | mariangela.pellegrini@surgsci.uu.se |
| Name | Affiliation | Role |
|---|---|---|
| Mariangela Pellegrini, MD, PhD | Uppsala University Hospital, Uppsala University | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40229445 | Derived | Bencze R, Kawati R, Hanell A, Lewen A, Enblad P, Engquist H, Bjarnadottir KJ, Joensen O, Barrueta Tenhunen A, Freden F, Brochard L, Perchiazzi G, Pellegrini M. 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. Intensive Care Med Exp. 2025 Apr 14;13(1):43. doi: 10.1186/s40635-025-00750-y. |
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blood gas analysis sampled daily shortly before respiratory mechanics data recording
Correlation between lung collapse and days of mechanical ventilation
| At ICU discharge, an average of 20 days |
| 90-days mortality from intensive care unit admission | Correlation between lung collapse and 90-days mortality | 90 days after hospital discharge |
| 30-day and 90-days neurological and functional outcomes | Correlation between lung collapse and 30-day and 90-days neurological and functional outcomes (Disability Rating Scale, clinical frailty score, Glasgow Outcome Scale) | 90 days after hospital discharge |
| ID | Term |
|---|---|
| D009422 | Nervous System Diseases |
| D055370 | Lung Injury |
| ID | Term |
|---|---|
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D013898 | Thoracic Injuries |
| D014947 | Wounds and Injuries |
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