Alveolar Recruitment in Brain Injury

Effects of Recruitment Maneuvers in Patients With Acute Brain Injury and Acute Lung Injury

Development of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in patients with severe brain injury has been associated with poor outcome. The application of lung recruitment maneuvers (RM) for a short period of time to open collapsed alveoli and reverse hypoxemia in early ARDS has been recommended. However, little is known about the cerebral and vascular effects of RM in brain injury patients with ALI/ARDS. The aim of this study is to assess the effects of a single standardized RM on oxygenation and on systemic and cerebral hemodynamics in severe brain injury patients with ALI/ARDS.

Study Overview

• Status: Completed
• Conditions: Brain Injury; Acute Lung Injury

Detailed Description

Patients with severe brain injury comprise a significant portion of admissions to critical care units. These patients are unable to adequately protect their airways and are usually intubated and mechanically ventilated. The goal of mechanical ventilation in patients with brain injury is to optimize blood gas exchange while minimizing intrathoracic pressure to avoid interference with cerebral venous drainage.Over the last 20 years, a plethora of experimental and clinical data have shown that mechanical ventilation can cause or aggravate lung damage in patients with acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). The aim of this pilot study was to assess the effects of a single standardized recruitment maneuver (RM) on oxygenation and on systemic and cerebral hemodynamics in severe brain injury patients with ALI/ARDS.

Only patients with brain injury, as defined by a Glasgow Coma Score <13, admitted into the Trauma and Surgical intensive care unit (ICU) will be studied.

After obtaining informed consent, a RM will be performed by switching the ventilator from assist/control ventilation to continuous positive airway pressure (CPAP) and applying a pressure of 40 cmH2O for 40 sec (11). After the RM, patients have been ventilated in pressure control ventilation and PEEP will be gradually reduced in decremental steps every 3 respiratory cycles starting with PEEP at 30 cm H2O, maintaining a maximum peak pressure of 40 cmH2O during this procedure until pre-RM PEEP levels are achieved. The RM will be discontinued if any of the following changes developed during the procedure: (i) ≥20% changes in baseline systemic blood pressure, (ii) ICP ≥20 mmHg, or (iii) SaO2 ≤90%. After the RM is performed, respiratory mechanics, arterial and SjO2 blood samples and systemic and cerebral hemodynamics will be obtained at 30 min and 8 hours.

• Study Type: Observational
• Enrollment (Actual): 9

Contacts and Locations

Study Locations

• Spain
  • Barcelona, Spain, 08036
    • Trauma and Surgical ICU, Hospital Clinic

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients with brain injury (Glasgow Coma Score<13) admitted into the Trauma and Surgical Intensive care unit (ICU) at the Hospital Clinic, Barcelona.

Description

Inclusion Criteria:

• Patients with brain injury who met the ALI/ARDS criteria within 72 hours after ICU admission

Exclusion Criteria:

• <18 years of age
• Cardiogenic edema
• Hemodynamic instability
• Intracranial hypertension

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Brain injury plus acute lung injury; Patients with severe brain injury (Glasgow coma score<13) with acute lung injury (PaO2/FiO2 <300 mmHg)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
arterial oxygenation	Arterial oxygenation was expressed as PaO2/FiO2 ratio	8 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
cerebral hemodynamics	Cerebral hemodynamics will be assessed by cerebral perfusion pressure and intracranial pressure	8 hours

Collaborators and Investigators

• Sponsor: Hospital Clinic of Barcelona
• Collaborators: Fondo de Investigacion Sanitaria
• Investigators: Principal Investigator: Elizabeth Zavala, MD, PhD, Hospital Clinic, Barcelona, Spain

Study record dates

Study Major Dates

• Study Start: February 1, 2001
• Study Completion (Actual): November 1, 2003

Study Registration Dates

• First Submitted: July 8, 2010
• First Submitted That Met QC Criteria: July 8, 2010
• First Posted (Estimate): July 9, 2010

Study Record Updates

• Last Update Posted (Estimate): July 9, 2010
• Last Update Submitted That Met QC Criteria: July 8, 2010
• Last Verified: February 1, 2001

More Information

Terms related to this study

• Keywords: mechanical ventilation; brain injury; acute lung injury; lung recruitment
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Respiratory Tract Diseases; Lung Diseases; Craniocerebral Trauma; Trauma, Nervous System; Thoracic Injuries; Brain Injuries; Wounds and Injuries; Acute Lung Injury; Lung Injury
• Other Study ID Numbers: RM-0152; FIS-0152 (Other Grant/Funding Number: Fondo de Investigaciones Sanitarias)