What should PEEP be set to for manual ventilation of an adult with a traumatic brain injury?

For manual ventilation of an adult with a traumatic brain injury, setting PEEP (positive end-expiratory pressure) to 5 cmH₂O is considered appropriate. This level of PEEP helps to maintain sufficient end-expiratory lung volume and oxygenation without compromising hemodynamics or causing excessive overdistention of the lungs.

In patients with traumatic brain injury, it's crucial to manage intracranial pressure (ICP) carefully. Excessively high PEEP can lead to increased intrathoracic pressure, which may further compromise venous return to the heart and therefore impact cerebral perfusion. A lower PEEP of 5 cmH₂O strikes a balance, ensuring the airways remain open and facilitating adequate ventilation while minimizing the risk of adverse effects on cardiovascular performance and ICP.

Using higher PEEP settings, such as 10 cmH₂O, 15 cmH₂O, or 20 cmH₂O can significantly increase intrathoracic pressure, which could exacerbate situations in patients with brain injuries. Thus, the recommendation for a setting of 5 cmH₂O is based on balancing the benefits of improved oxygenation and minimizing risks to hemodynamics and intracranial pressures.