Background and Goal:
Adult respiratory distress syndrome (ARDS) can be a common problem associated with the treatment of traumatic brain injury (TBI) patients. However TBI patients often have raised intracranial pressures (ICP). Airway pressure release Ventilation (APRV) is a pressure limited and time cycled mode of ventilation characterised by maintenance of high airway pressures for a long period of time1,2. APRV is invaluable in the treatment of ARDS when the conventional ventilatory strategies are not helpful. We looked at the suitability of APRV in TBI patients.
Materials and Methods:
] We conducted a Retrospective case series study from January 2010 to August 2011. Patients with TBI who had ICP bolt and who were on APRV were included in the study. During our study period there were 10 patients who matched the above criteria. We recorded their ICP, PaCO2 (Arterial Partial pressure of Carbon dioxide) and PaO2 (Arterial Partial pressure of Oxygen) 8 hours prior to being started on APRV and 12 hours after being commenced on it.
We observed that the patients did not have a significant or sustained increase in ICP, there was an improvement in their PaO2.The PaCO2 was well controlled despite patients being heavily sedated.
We therefore recommend APRV as a safe mode of ventilation in ARDS patients with TBI. We have used it successfully in our unit, avoiding oscillators and prone ventilation of our TBI patients.
Downs, JB, et. al. Airway pressure release ventilation: A new concept in ventilatory support. Crit Care Med 1987; 15:459.Stock, MC, et. al. Airway pressure release ventilation. Crit Care Med1987; 15:462.
ICP, PaCO2 and PaO2 Mean Values:
© 2012 European Society of Anaesthesiology