• Sérgio Nogueira Nemer, Jefferson B Caldeira, Ricardo G Santos, Bruno L Guimarães, João Márcio Garcia, Darwin Prado, Ricardo T Silva, Leandro M Azeredo, Eduardo R Faria, and Paulo Cesar P Souza.
• Complexo Hospitalar de Niterói. Rua La Salle 12, Centro, Niterói, Rio de Janeiro, CEP: 24020-090, Brazil; Hospital da Polícia Militar de Niterói. Rua Martins Torres 245, Santa Rosa, Niterói, Rio de Janeiro, CEP: 24240-705, Brazil; Universidade UNIGRANRIO. Rua José de Souza Herdy 1160, Jardim Vinte e Cinco de Agosto, Duque de Caxias, CEP: 25071-202, Brazil. Electronic address: snnemer@gmail.com.
• J Crit Care. 2015 Dec 1; 30 (6): 1263-6.

PurposeTo verify whether high positive end-expiratory pressure levels can increase brain tissue oxygen pressure, and also their effects on pulse oxygen saturation, intracranial pressure, and cerebral perfusion pressure.Material And MethodsTwenty traumatic brain injury patients with acute respiratory distress syndrome were submitted to positive end-expiratory pressure levels of 5, 10, and 15 cm H2O progressively. The 3 positive end-expiratory pressure levels were used during 20 minutes for each one, whereas brain tissue oxygen pressure, oxygen saturation, intracranial pressure, and cerebral perfusion pressure were recorded.ResultsBrain tissue oxygen pressure and oxygen saturation increased significantly with increasing positive end-expiratory pressure from 5 to 10 and from 10 to 15 cm H2O (P=.0001 and P=.0001 respectively). Intracranial pressure and cerebral perfusion pressure did not differ significantly with increasing positive end-expiratory pressure from 5 to 10 and from 10 to 15 cm H2O (P=.16 and P=.79 respectively).ConclusionsHigh positive end-expiratory pressure levels increased brain tissue oxygen pressure and oxygen saturation, without increase in intracranial pressure or decrease in cerebral perfusion pressure. High positive end-expiratory pressure levels can be used in severe traumatic brain injury patients with acute respiratory distress syndrome as a safe alternative to improve brain oxygenation.Copyright © 2015 Elsevier Inc. All rights reserved.

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