Lung protection strategy permising hypercapnia induces the development of cranial hyperemia and hypertension. On the other hand, “aggressive” ventilation with high tidal volume may aggravate lung injury and provoke ventilator-associated lung damage(9). In mechanical ventilation treatment, PEEP improves oxygenation by recruitment of atelectatic alveolar units, improving FRC and preventing atelectrauma. Also it may have detrimental neurologic effects in certain clinical circumstances(10). In a recent study in patients with traumatic brain injury shows that increasing PEEP up to 15 cm H2O to optimize oxygenation has not been associated with reduced cerebral perfusion pressure or acute intracranial hypertension
