Primary objective: To investigate the safety and efficacy of high positive end-expiratory pressure (PEEP) ventilation strategy for acute respiratory distress syndrome (ARDS) after traumatic brain injury.
Research design: A case report and discussion based on literature review.
Methods and procedures: This article reports the case of a 17-year-old male patient who developed ARDS after severe traumatic brain injury. PEEP was applied and adjusted to appropriate levels on the basis of information obtained from continuous monitoring of cerebral and systemic haemodynamics. Data from medical charts, surgical notes and radiographic findings were reviewed and analysed.
Main outcomes and results: With the application of high PEEP ventilation, the patient survived ARDS following severe traumatic brain injury and achieved a favourable neurological outcome. A titration of PEEP levels from 5-15 cm H₂O in the patient resulted in acceptable changes of cerebral and systemic haemodynamics, including an increase of intracranial pressure (ICP) from 15 to 18 mmHg and a decrease of cerebral perfusion pressure (CPP) from 78 to 72 mmHg.
Conclusions: With close monitoring of cerebral and systemic haemodynamics, PEEP can be safely applied and titrated to an optimal level in the management of ARDS following traumatic brain injury.