The influence of positive end-expiratory pressure on central venous pressure in patients with severe craniocerebral injury

Abstract

To observe the impact of positive end-expiratory pressure (PEEP) on central venous pressure (CVP) in mechanically ventilated patients with severe craniocerebral injury. A prospective, interventional, self-control study was conducted. Thirty severe craniocerebral injury patients with central respiratory failure were enrolled. The changes in CVP, mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation [SpO2] were monitored at different PEEP levels [0, 3, 6, 9, 12, 15 cm H2O; 1 cm H2O=0.098 kPa] during mechanical ventilation and after weaning of mechanical ventilation. The influences of PEEP and its discontinuance on haemodynamics and oxygenation were analyzed. The values of CVP [cm H2O] were increased when PEEP increased (from 7.9±3.1 to 13.1±3.7), a linear correlation was found (R=0.509, P=0.000), and linear regression equation was CVP [cm H2O]=7.774+0.368×PEEP [cm H2O]; CVP was elevated about 0.368 cm H2O when PEEP increased 1 cm H2O. CVP values significantly decreased during discontinuance of mechanical ventilation, as compared to those measured at different PEEP levels during mechanical ventilation (F=24.429, P=0.000). The values of MAP, HR and SpO2 showed no significant change with increase of PEEP levels [MAP (mm Hg, 1 mm Hg=0.133 kPa): from 81.6±10.4 to 85.6±10.6; HR (beats per minute): from 79.9±13.5 to 88.1±15.4; SpO2: from 0.968±0.036 to 0.975±0.033, all P>0.05] in mechanically ventilated patients, but discontinuance of mechanical ventilation could significantly increase the levels of MAP and HR (95.3±8.4 and 94.9±10.3, respectively) and lower SpO2 levels (0.928±0.036, all P=0.000). CVP values were overestimated during an increase in PEEP in mechanically ventilated patients with severe craniocerebral injury. CVP was increased about 0.368 cm H2O following an increase of PEEP of 1 cm H2O, whereas the values of MAP, HR and SpO2 showed no significant change with increase in PEEP levels. This study could offer a theoretical base in the correct assessment of CVP values at different PEEP levels without discontinuation of mechanical ventilation.