NEUROINTENSIVISMO NA SÍNDROME DO DESCONFORTO RESPIRATÓRIO AGUDO (SDRA): A PRESSÃO EXPIRATÓRIA POSITIVA FINAL (PEEP) COMPROMETE A PRESSÃO DE PERFUSÃO CEREBRAL (PPC)?

The cerebral perfusion pressure (CPP) should be monitored continuously in neurocritical patients. Because repercussions in this clinical variable can worsen quite the patient's prognosis. In acute respiratory distress syndrome (ARDS) there are necessity of positive end-expiratory pressure (PEEP) ideal for maintaining adequate oxygenation. However, the increase intrathoracic pressure in some cases is associated with increased intracranial pressure (ICP) and reduced cerebral blood flow. The purpose of article was ascertain the influence of PEEP in CPP in neurocritical patients with ARDS. The research is a narrative review, that used descriptors: "cerebral perfusion pressure", "positive end-expiratory pressure", "intracranial pressure", "acute respiratory distress syndrome", and their respective in Portuguese, in isolation and intersection way, delimited to period 2007-2017. Patients with brain injury and ARDS are at increased risk of developing secondary brain injury due to hypoxemia. It has been found that the alveolar recruitment maneuver is a commonly used strategy. The use of PEEP up to 15 cm H2O does not cause significant repercussions on ICP and CPP. We concluded that the use of PEEP should be encouraged in neurocritical patients with ARDS in order to correct hypoxemia and better cerebral oxygenation, but hemodynamics and cerebral metabolism should be monitored. [ABSTRACT FROM AUTHOR]