The consensus is that Positive End-Expiratory Pressure (PEEP) can be safely used in most patients with Acute Brain Injury (ABI), provided its effects on the brain are closely monitored.

PEEP Safety and ICP: While PEEP can potentially increase Intracranial Pressure (ICP), this change is usually negligible in patients whose lungs maintain good elasticity.

Individualized PEEP: The optimal PEEP level must be individualized for each patient and may need to change over time, balancing the need for lung protection with cerebral safety.

Essential Neuro-Monitoring: Multimodal neuro-monitoring (such as PtiO2, microdialysis, and cerebral autoregulation indices like the Pressure Reactivity Index) is essential. This monitoring should be used not just for intracranial hypertension, but to continuously guide respiratory management and anticipate the brain’s response to PEEP.

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