Evaluation of Intracranial Pressure During Mechanical Ventilation Recruitment Maneuver

The therapeutic goal of mechanical ventilation shifts from maintaining regular gas exchange to preventing ventilator-induced lung injury. Atelectasis aggravates lung injury by reducing the lung size available for tidal ventilation. By preventing atelectasis with Positive End Expiratory Pressure (PEEP) and recruitment maneuvers, the end-expiratory lung volume can be increased, and lung damage can be reduced.

Although the recruitment maneuver improves oxygenation and reduces mortality, especially in patients with Acute Respiratory Distress Syndrome (ARDS), adverse side effects are sometimes observed. Most important of these are the risk of barotrauma after positive airway pressure applications, increased intrathoracic pressure and hemodynamic instability, and increased intracranial pressure risk after venous return disorder.

Our study aimed to evaluate the effect of recruitment maneuver on intracranial pressure by measuring optic nerve diameter with ultrasound before and after its application in patients with ARDS with impaired oxygenation and followed up with mechanical ventilator support.

Inclusion criteria

• Patients older than 18 years
• Patients followed in the Intensive Care Unit (ICU)
• Patients on mechanical ventilation support
• Patients diagnosed with ARDS according to the Berlin criteria
• Patients with oxygen saturation (SpO2) ≤ 92%

Exclusion criteria

• Younger than 18
• Patients with increased inotropic drug requirement or mean arterial pressure <65 mmHg in the last 2 hours
• Patients with intracranial hypertension
• Patients with acute coronary syndrome
• Patients with hypercapnia, pneumothorax, subcutaneous emphysema, and pneumomediastinum