BrainVent

Patients suffering from acute brain injury (ABI) after stroke or trauma often require mechanical ventilation (MV) with a potential to develop ventilator-induced lung injury (VILI), prolonging time on ventilator, increasing intensive care unit (ICU) stay and delaying time to critical rehabilitation. Since pulmonary complications are common in this patient category, lung protective ventilation has emerged as the method of choice to prevent VILI. However, the relationships between ICP, cerebral autoregulation and lung protective ventilation with higher positive end-expiratory pressure (PEEP) are still unsettled. Recent studies indicate that PEEP need to be individualized based on measurement of transpulmonary pressure (TPP). So far, few studies have addressed the relationships between TPP, ICP, brain oxygenation and cerebral autoregulation. The influence of mechanical ventilation variables (PEEP, tidal volume and TPP) on multimodal neuromonitoring parameters might provide evidence for the best MV strategy to guide the management of brain injury simultaneously reducing the occurrence of respiratory complications that may delay recovery and rehabilitation.

We use a new clinical research software solution, ICM+, that offers high-resolution data collection and real time analysis from multiple bedside monitoring sources, promoting personalised medicine. Together with the ICM+ team at Brain Physics Laboratory, the University of Cambridge, we aim to address this issue and simultaneously improve the ICM+ technology further. Conclusively, we expect that the study will provide us with the opportunity to optimize ventilation in favour of maintaining normal ICP and autoregulation of cerebral blood flow, simultaneously avoiding a kind of mechanical ventilation that might cause VILI. In this project we also address lung-brain interaction in acute respiratory distress syndrome (ARDS) and intracranial hypertension.

The research questions are explored by clinical and experimental study design.

Chief Investigator: Shirin Kordasti Frisvold

Internal members: Rønnaug Hammervold, Jon André Totland, Tor Ingebrigtsen, Ellisiv B. Mathiesen, Linn H. Steffensen

External collaborators: Peter Smielewski, Erta Beqiri and Marek Czosnyka (al at the Brain Physics Laboratorium, Cambridge Neuroscience, University of Cambridge, UK), Claude Guerin (University Hospital of Lyon, France), Erik Waage Nielsen and Benjamin Storm (both at Nordland Hospital Bodø, Nord University, Bodø)