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Original article
Available online 30 May 2024
Effects of PEEP on intracranial pressure in patients with acute brain injury: An observational, prospective and multicenter study
Efectos de la PEEP sobre la Presión Intracraneal en pacientes con lesion cerebral aguda: estudio prospectivo, observacional y multicéntrico
Jesús Abelardo Barea-Mendoza, Zaira Molina-Collado, María Ángeles Ballesteros-Sanz, Luisa Corral-Ansa, Maite Misis del Campo, Cándido Pardo-Rey, Juan Angel Tihista-Jiménez, Carmen Corcobado-Márquez, Juan Pedro Martín del Rincón, Juan Antonio Llompart-Pou, Luis Alfonso Marcos-Prieto, Ander Olazabal-Martínez, Rubén Herrán-Monge, Ana María Díaz-Lamas, Mario Chico-Fernández
Corresponding author
Intensive Medicine Department, UCI de Trauma y Emergencias, UCITE, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
Received 13 January 2024. Accepted 29 April 2024
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Table 1. Ventilatory, hemodynamic and neuromonitoring responses to PEEP increase (n = 138 episodes).
Table 2. Ventilatory, hemodynamic and neuromonitoring responses to PEEP decrease (n = 66 episodes).
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To analyze the impact of positive end-expiratory pressure (PEEP) changes on intracranial pressure (ICP) dynamics in patients with acute brain injury (ABI).


Observational, prospective and multicenter study (PEEP-PIC study).


Seventeen intensive care units in Spain.


Neurocritically ill patients who underwent invasive neuromonitorization from November 2017 to June 2018.


Baseline ventilatory, hemodynamic and neuromonitoring variables were collected immediately before PEEP changes and during the following 30 min.

Main variables of interest

PEEP and ICP changes.


One-hundred and nine patients were included. Mean age was 52.68 (15.34) years, male 71 (65.13%). Traumatic brain injury was the cause of ABI in 54 (49.54%) patients. Length of mechanical ventilation was 16.52 (9.23) days. In-hospital mortality was 21.1%. PEEP increases (mean 6.24–9.10 cmH2O) resulted in ICP increase from 10.4 to 11.39 mmHg, P < .001, without changes in cerebral perfusion pressure (CPP) (P = .548). PEEP decreases (mean 8.96 to 6.53 cmH2O) resulted in ICP decrease from 10.5 to 9.62 mmHg (P = .052), without changes in CPP (P = .762). Significant correlations were established between the increase of ICP and the delta PEEP (R = 0.28, P < .001), delta driving pressure (R = 0.15, P = .038) and delta compliance (R = −0.14, P = .052). ICP increment was higher in patients with lower baseline ICP.


PEEP changes were not associated with clinically relevant modifications in ICP values in ABI patients. The magnitude of the change in ICP after PEEP increase was correlated with the delta of PEEP, the delta driving pressure and the delta compliance.

Acute brain injury
Intracranial pressure
Positive end-expiratory pressure
Mechanical ventilation
Neurocritical care

Analizar el impacto de los cambios en la Presión positiva al final de la espiración (PEEP) sobre la Presión Intracraneal (PIC) en pacientes con lesión cerebral aguda (ABI).


Estudio prospectivo, observacional y multicéntrico (PEEP-PIC).


Diecisiete Unidades de Cuidados Intensivos en España.


Pacientes neurocríticos que recibieron monitorización invasiva de la PIC desde Noviembre 2017 hasta Junio 2018.


Se recogieron los parámetros ventilatorios, hemodinámicos y variables de neuromonitorización inmediatamente antes de las modificaciones de la PEEP y durante los 30 minutos posteriores.

Variables de interés principales

PEEP y cambios en la PIC.


Se incluyeron 109 pacientes. Edad media 52,68 (15,34) años, hombres 71 (65,13%). La causa de lesión cerebral fue traumática en 54 pacientes (49,54%). La estancia media fue de 16,52 (9,23) días. La mortalidad hospitalaria fue del 21,1%. Los aumentos de PEEP (media 6,24 a 9,10 cmH2O) resultaron en un aumento de la PIC de 10,4 a 11,39 mmHg, P < .001, sin cambios en la PPC (P = ,548). Los descensos de la PEEP (media 8,96 a 6,53 cmH2O) resultaron en un descenso de la PIC de 10,5 a 9,62 mmHg (P = ,052), sin cambios en la PPC (P = ,762). Se establecieron correlaciones significativas entre el aumento de PIC y el delta de PEEP (R = 0,28, P < ,001), el delta driving pressure (R = 0,15, P = ,038) y el delta de complianza (R = −0,14, P = ,052). El aumento de PIC fue mayor en pacientes con PIC basal baja.


Los cambios en la PEEP no se asociaron a cambios clínicamente relevantes en la PIC de los pacientes con lesion cerebral aguda. La magnitud del aumento de la PIC tras el aumento de PEEP se correlacionó con el delta PEEP, delta driving pressure y el delta complianza.

Palabras clave:
Lesión cerebral
Presión intracraneal
Ventilación mecánica


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