The effect of mechanical ventilation on intracranial pressure in experimental hemispheric ischemic stroke in rabbits: a study protocol

Mechanical ventilation (MV) in patients with acute cerebral injury, particularly ischemic stroke (IS), has a number of specific considerations related to the influence of inspiratory control and positive end-expiratory pressure (PEEP) on intracranial pressure (ICP). Data on the impact of these parameters are limited and contradictory. Objective. To develop a study design to assess the impact of the inspiratory control option and PEEP level during mechanical ventilation on the parameters of intracranial homeostasis in experimental ischemic stroke. Material and methods. A crossover experimental study is planned on 14 rabbits. Hemispheric IS is planned to be modeled in 10 rabbits using bilateral occlusion of the left common carotid artery (CCA) under general anesthesia and mechanical ventilation, with invasive monitoring of ICP, ventilation parameters, vital signs, blood gases and acid-base balance. Four rabbits in the control group are planned to undergo general anesthesia and MV with invasive monitoring the same parameters, combined with a “sham” operation. After the initiation of ICP monitoring, MV is performed in four 45-minute periods with alternating inspiratory control mode, followed by three 45-minute periods with PEEP levels of 5, 10, and 15 cm H2O. For the first stage, 20 values of monitored parameters are analyzed in each study group (with pressure and volume control), 8 values of monitored parameters in each control group (with pressure and volume control); for the second stage — 10 values of monitored parameters in the study group at each PEEP level, 4 values of monitored parameters in the control group at each PEEP level. Conclusion. This study will provide data that will further our understanding of the impact of mechanical ventilation on ICP in patients with ischemic stroke and will be valuable for personalized intensive care for this patient population.