Positive end-expiratory pressure (PEEP) and cerebrospinal fluid pressure during normal and elevated intracranial pressure in dogs

We investigated possible mechanisms by which positive end-expiratory pressure (PEEP) increased cerebrospinal fluid pressure (PCSF) in anesthetized mechanically ventilated dogs. In part I of the study, PEEP was applied in 5 cmH2O increments each lasting 1–2 min, before and after a snare separated the spinal from the cerebral subarachnoid space in each animal. Next, with the spinal cord still ligated, the dogs were ventilated without PEEP while superior vena cava pressure (PSVC) was raised in 5 cmH2O increments by means of a fluid reservoir connected with the superior vena cava. Cerebrospinal fluid pressure in the cisterna magna increased immediately and in parallel with PEEP before and after the spinal subarachnoid space was occluded and also increased when PSVC was raised independently; in all circumstances the increase in PCSF correlated closely with PSVC (r = 0.926). In part II of the study, arterial blood gases were drawn before and after PEEP was applied in the same increments and for the same duration as in part I. Cerebrospinal fluid pressure measured with a hollow skull screw again rose in parallel with PEEP, whereas arterial carbon dioxide tension rose only slightly at 60 s. In part III of the study, mean arterial pressure (Pa) was allowed to decrease with PEEP or was held constant by distal aortic obstruction and volume infusion. Cerebrospinal fluid pressure increased regardless of Pa, but the increase was greater when Pa was held constant than when it fell with PEEP. We conclude that PEEP increases PCSF primarily by increasing PSVC and decreasing cerebral venous outflow. This effect is augmented if cerebral arterial inflow is increased as well.

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Intracranial pressure, its components and cerebrospinal fluid pressure-volume compensation

Acta Neurologica Scandinavica ◽

10.1111/ane.12541 ◽

2015 ◽

Vol 134 (3) ◽

pp. 168-180 ◽

Cited By ~ 26

Author(s):

M. Kasprowicz ◽

D. A. Lalou ◽

M. Czosnyka ◽

M. Garnett ◽

Z. Czosnyka

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Fluid Pressure ◽

Cerebrospinal Fluid Pressure

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Lumbar cerebrospinal fluid pressure waves versus intracranial pressure waves in idiopathic normal pressure hydrocephalus

British Journal of Neurosurgery ◽

10.1080/02688690601047312 ◽

2006 ◽

Vol 20 (6) ◽

pp. 407-414 ◽

Cited By ~ 21

Author(s):

P. K. Eide ◽

A. Brean

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Normal Pressure Hydrocephalus ◽

Fluid Pressure ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Cerebrospinal Fluid Pressure ◽

Pressure Waves ◽

Lumbar Cerebrospinal Fluid

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Reference Values For Intracranial Pressure And Lumbar Cerebrospinal Fluid Pressure: A Systematic Review

10.21203/rs.3.rs-143580/v1 ◽

2021 ◽

Author(s):

Nicolas Hernandez Norager ◽

Markus Harboe Olsen ◽

Sarah Hornshoej Pedersen ◽

Casper Schwartz Riedel ◽

Marek Czosnyka ◽

...

Keyword(s):

Systematic Review ◽

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Reference Values ◽

Supine Position ◽

Body Position ◽

Fluid Pressure ◽

Reference Intervals ◽

Cerebrospinal Fluid Pressure ◽

Lumbar Cerebrospinal Fluid

Abstract BackgroundAlthough widely used in the evaluation of the diseased, normal intracranial pressure and lumbar cerebrospinal fluid pressure remains sparsely documented. Intracranial pressure is different from lumbar cerebrospinal fluid pressure. In addition, intracranial pressure differs considerably according to body position of the patient. Despite this, the current reference interval are used indistinguishable for intracranial and lumbar cerebrospinal fluid pressure, and body position dependent reference intervals does not exist. In this study, we aim to establish these reference intervals.MethodA systematic search was conducted in MEDLINE, EMBASE, CENTRAL, and Web of Sciences. Methodological quality was assessed using an amended version of the Joanna Briggs Quality Appraisal Checklist. Intracranial pressure and lumbar cerebrospinal fluid pressure were independently evaluated and subdivided into body positions. Quantitative data were presented with mean ± SD, and 90% reference intervals.ResultsThirty-six studies were included. Nine studies reported values for intracranial pressure, while 27 reported values for the lumbar cerebrospinal fluid pressure. Reference values for intracranial pressure were -5.9 to 8.3 mmHg in the upright position and 0.9 to 16.3 mmHg in supine position. Reference values for lumbar cerebrospinal fluid pressure were 7.2 to 16.8 mmHg and 5.7 to 15.5 mmHg in the lateral recumbent position and supine position, respectively. ConclusionsThis systematic review is the first to provide position-dependent reference values for intracranial pressure and lumbar cerebrospinal fluid pressure. Clinically applicable reference values for normal lumbar cerebrospinal fluid pressure was established, and were in accordance with previously used reference values. For intracranial pressure, this study strongly emphasizes the scarse normal material, and highlights the need for further research on the matter.

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The Effect of Positive End-Expiratory Pressure Ventilation (PEEP) on Cerebral Blood Flow and Cerebrospinal Fluid Pressure in Goats

Anesthesiology ◽

10.1097/00000542-198109000-00010 ◽

1981 ◽

Vol 55 (3) ◽

pp. 244-250 ◽

Cited By ~ 23

Author(s):

D. D. Doblar ◽

T. V. Santiago ◽

Arif U. Kahn ◽

N. H. Edelman

Keyword(s):

Blood Flow ◽

Cerebrospinal Fluid ◽

Cerebral Blood Flow ◽

Fluid Pressure ◽

Cerebrospinal Fluid Pressure ◽

Positive End Expiratory Pressure

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Reference values for intracranial pressure and lumbar cerebrospinal fluid pressure: a systematic review

Fluids and Barriers of the CNS ◽

10.1186/s12987-021-00253-4 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Nicolas Hernandez Norager ◽

Markus Harboe Olsen ◽

Sarah Hornshoej Pedersen ◽

Casper Schwartz Riedel ◽

Marek Czosnyka ◽

...

Keyword(s):

Systematic Review ◽

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Reference Values ◽

Supine Position ◽

Body Position ◽

Fluid Pressure ◽

The Body ◽

Cerebrospinal Fluid Pressure ◽

Lumbar Cerebrospinal Fluid

Abstract Background Although widely used in the evaluation of the diseased, normal intracranial pressure and lumbar cerebrospinal fluid pressure remain sparsely documented. Intracranial pressure is different from lumbar cerebrospinal fluid pressure. In addition, intracranial pressure differs considerably according to the body position of the patient. Despite this, the current reference values do not distinguish between intracranial and lumbar cerebrospinal fluid pressures, and body position-dependent reference values do not exist. In this study, we aim to establish these reference values. Method A systematic search was conducted in MEDLINE, EMBASE, CENTRAL, and Web of Sciences. Methodological quality was assessed using an amended version of the Joanna Briggs Quality Appraisal Checklist. Intracranial pressure and lumbar cerebrospinal fluid pressure were independently evaluated and subdivided into body positions. Quantitative data were presented with mean ± SD, and 90% reference intervals. Results Thirty-six studies were included. Nine studies reported values for intracranial pressure, while 27 reported values for the lumbar cerebrospinal fluid pressure. Reference values for intracranial pressure were − 5.9 to 8.3 mmHg in the upright position and 0.9 to 16.3 mmHg in the supine position. Reference values for lumbar cerebrospinal fluid pressure were 7.2 to 16.8 mmHg and 5.7 to 15.5 mmHg in the lateral recumbent position and supine position, respectively. Conclusions This systematic review is the first to provide position-dependent reference values for intracranial pressure and lumbar cerebrospinal fluid pressure. Clinically applicable reference values for normal lumbar cerebrospinal fluid pressure were established, and are in accordance with previously used reference values. For intracranial pressure, this study strongly emphasizes the scarcity of normal pressure measures, and highlights the need for further research on the matter.

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Post-dural puncture headache: Epidemiology, onset mechanisms, clinical symptoms, diagnosis and therapy

Medicinski pregled ◽

10.2298/mpns1912383s ◽

2019 ◽

Vol 72 (11-12) ◽

pp. 383-388

Author(s):

Svetlana Simic ◽

Aleksandar Kopitovic ◽

Tamara Rabi-Zikic ◽

Jelena Knezevic ◽

Ljiljana Radmilo ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Dural Puncture ◽

Clinical Symptoms ◽

Fluid Pressure ◽

Cerebrospinal Fluid Pressure ◽

Secondary Headache ◽

Post Dural Puncture Headache ◽

Diagnosis And Therapy ◽

Greater Occipital Nerve

Introduction. Post-dural puncture headache is classified as a secondary headache attributable to non-vascular intracranial disorders and belongs to the group of headaches caused by low cerebrospinal fluid pressure. Etiopathogenesis. The pathogenesis is not completely clear, but it is thought to be caused by the cerebrospinal fluid leak through the duct opening. Cerebrospinal fluid efflux leads to a decrease in intracranial pressure and stretching of the pain sensitive intracranial structures. A drop in intracranial pressure can cause compensatory cerebrovascular vasodilation, contributing to the onset of a headache. Diagnosis and Therapy. Post-dural puncture headache clinically presents as an orthostatic headache. In most cases, the diagnosis is made based on a typical clinical picture and it can be confirmed by magnetic resonance imaging and measurement of cerebrospinal fluid pressure. The condition is usually benign, most often with spontaneous recovery. The therapy involves conservative treatment, medications, as well as some invasive methods: epidural blood patches, blockage of the greater occipital nerve, and in most severe cases, epidural injection of fibrin sealant or surgical dural repair. Conclusion. Post-dural puncture headache is a common complaint in the clinical practice of neurologists and anesthesiologists. The prognosis is usually favourable, while the therapy may include conservative or invasive treatment procedures.

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Effect of positive end-expiratory pressure on intracranial pressure in dogs

Journal of Applied Physiology ◽

10.1152/jappl.1978.44.1.25 ◽

1978 ◽

Vol 44 (1) ◽

pp. 25-27 ◽

Cited By ~ 34

Author(s):

J. S. Huseby ◽

E. G. Pavlin ◽

J. Butler

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Pulmonary Edema ◽

Cerebral Perfusion Pressure ◽

Cerebral Perfusion ◽

Perfusion Pressure ◽

Fluid Pressure ◽

Lung Compliance ◽

Positive End Expiratory Pressure ◽

Increased Intracranial Pressure

Application of positive end-expiratory pressure to dogs with noncardiogenic pulmonary edema increased intracranial pressure (measured as cerebrospinal fluid pressure) and decreased cerebral perfusion pressure. The magnitude of these changes depended on the amount of end-expiratory pressure applied and the lung compliance.

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Intracranial hypertension following neck dissection

The Journal of Laryngology & Otology ◽

10.1017/s0022215100101239 ◽

1986 ◽

Vol 100 (12) ◽

pp. 1427-1432 ◽

Cited By ~ 16

Author(s):

W. A. E. J. de Vries ◽

A. J. M. Balm ◽

R. M. Tiwari

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Neck Dissection ◽

Radical Neck Dissection ◽

Fluid Pressure ◽

Anatomical Variations ◽

Cerebrospinal Fluid Pressure ◽

Increased Intracranial Pressure ◽

Specific Therapy ◽

The Brain

AbstractA 51-year-old man developed prolonged papilloedema as a result of increased cerebrospinal fluid pressure following staged bilateral radical neck dissection. The patient recovered completely with no further specific therapy. Although the prognosis for vision is usually good in patients with longstanding papilloedema due to raised cerebrospinal fluid pressure, permanent visual impairment remains a serious complication. In the presence of anatomical variations of the venous pathways by which the blood leaves the brain, a raised intracranial pressure may also develop following unilateral radical neck dissection. Nine cases of increased intracranial pressure following unilateral radical neck dissection reported in the literature until now are briefly reviewed.

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