Mechanical ventilation in neurocritical care patients: a systematic literature review

Borsellino, Beatrice; Schultz, Marcus J.; Abreu, Marcelo Gama de; Robba, Chiara; Bilotta, Federico

doi:10.1080/17476348.2017.1235976

Cited by 78 publications

(88 citation statements)

References 51 publications

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“…Patients refractory to ventilatory therapies, recruitment manoeuvres or prone position may be eligible to ECMO therapy, although no general consensus has been reached. Special care has to be taken with neuro-patients because all of these strategies can increase the risk of intracranial hypertension [15,16]. The whole cerebral haemodynamic system can be affected, decreasing both cerebral perfusion pressure (CPP) and cerebral blood flow (CBF).…”

Section: Timingmentioning

confidence: 99%

Extra Corporeal Life Support in Traumatic Brain Injury Patients

López¹,

Torre²,

Bilotta³

et al. 2019

obm neurobiol

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Purpose of review: The purpose of this review is to describe recent evidence regarding the use of Extracorporeal Membrane Oxygenation (ECMO) as rescue therapy for refractory cardiac or respiratory failure in patients with traumatic brain injury (TBI) when conventional treatments have failed. The characteristics of these patients, including the risk of bleeding and developing malignant intracranial hypertension, are generally considered as relative contraindications to ECMO treatment; however, recent evidence suggests that the use of ECMO should be considered even in this cohort. Recent findings: Recent findings suggest that venous-venous (V-V) ECMO can be feasible in the treatment of severe acute respiratory distress syndrome (ARDS) TBI-related. Venousarterial (V-A) ECMO has emerged as a salvage intervention in TBI patients complicated with cardiogenic shock and after cardiac arrest. Improvement of ECMO techniques, including the introduction of centrifugal pumps and heparin-coated circuits, are progressively reducing the amount of heparin required. Moreover, the application of low dose heparin or heparinfree protocols anticoagulation in ECMO has shown good outcome and minimal bleeding and thrombotic complications. Summary: ECMO can be considered as a safe and feasible rescue therapy even in TBI patients. However, there is a lack of evidence. Further studies are warranted, focusing on brain trauma patients undergoing ECMO to better clarify the effect on survival, the type and dose of anticoagulation, and the utility of dedicated multidisciplinary trauma-ECMO units.

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Section: Timingmentioning

confidence: 99%

Extra Corporeal Life Support in Traumatic Brain Injury Patients

López¹,

Torre²,

Bilotta³

et al. 2019

obm neurobiol

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“…The utility of these strategies has been proved in several groups of patients, both during anaesthesia and in critical care (8,9); however, their use in neurocritical care patients is still uncertain, as most of these lung protective ventilatory strategies are associated with an increased risk of intracranial hypertension (9).…”

Section: Review Articlementioning

confidence: 99%

Acute respiratory distress syndrome in traumatic brain injury: how do we manage it?

Torre¹,

Badenes²,

Corradi³

et al. 2017

J. Thorac. Dis.

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Traumatic brain injury (TBI) is an important cause of morbidity and mortality worldwide. TBI patients frequently suffer from lung complications and acute respiratory distress syndrome (ARDS), which is associated with poor clinical outcomes. Moreover, the association between TBI and ARDS in trauma patients is well recognized. Mechanical ventilation of patients with a concomitance of acute brain injury and lung injury can present significant challenges. Frequently, guidelines recommending management strategies for patients with traumatic brain injuries come into conflict with what is now considered best ventilator practice. In this review, we will explore the strategies of the best practice in the ventilatory management of patients with ARDS and TBI, concentrating on those areas in which a conflict exists. We will discuss the use of ventilator strategies such as protective ventilation, high positive end expiratory pressure (PEEP), prone position, recruitment maneuvers (RMs), as well as techniques which at present are used for 'rescue' in ARDS (including extracorporeal membrane oxygenation) in patients with TBI. Furthermore, general principles of fluid, haemodynamic and hemoglobin management will be discussed. Currently, there are inadequate data addressing the safety or efficacy of ventilator strategies used in ARDS in adult patients with TBI. At present, choice of ventilator rescue strategies is best decided on a case-by-case basis in conjunction with local expertise.

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“…Traditionally, in TBI patients, low PEEP and high TVs are generally applied for tight CO 2 control [5]; however, recent evidence suggests that, even in TBI patients, the use of high TVs is associated with the development of acute lung injury [9,11]. As such, brain-injured patients have been excluded from the major trials exploring the effect of lung-protective ventilation strategies in ARDS [12,13], and consequently optimal ventilatory strategies have not been established yet in this setting [14,15]. We therefore performed an international survey with the aim to investigate the practice in the respiratory management of TBI patients, with and without respiratory failure.…”

Section: Introductionmentioning

confidence: 99%

VENTILatOry strategies in patients with severe traumatic brain injury: the VENTILO Survey of the European Society of Intensive Care Medicine (ESICM)

Picetti

Pelosi²,

Taccone

et al. 2020

Crit Care

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Background: Severe traumatic brain injury (TBI) patients often develop acute respiratory failure. Optimal ventilator strategies in this setting are not well established. We performed an international survey to investigate the practice in the ventilatory management of TBI patients with and without respiratory failure.Methods: An electronic questionnaire, including 38 items and 3 different clinical scenarios [arterial partial pressure of oxygen (PaO 2 )/inspired fraction of oxygen (FiO 2 ) > 300 (scenario 1), 150-300 (scenario 2), < 150 (scenario 3)], was available on the European Society of Intensive Care Medicine (ESICM) website between November 2018 and March 2019. The survey was endorsed by ESICM. Results: There were 687 respondents [472 (69%) from Europe], mainly intensivists [328 (48%)] and anesthesiologists [206 (30%)]. A standard protocol for mechanical ventilation in TBI patients was utilized by 277 (40%) respondents and a specific weaning protocol by 198 (30%). The most common tidal volume (TV) applied was 6-8 ml/kg of predicted body weight (PBW) in scenarios 1-2 (72% PaO 2 /FIO 2 > 300 and 61% PaO 2 /FiO 2 150-300) and 4-6 ml/kg/ PBW in scenario 3 (53% PaO 2 /FiO 2 < 150). The most common level of highest positive end-expiratory pressure (PEEP) used was 15 cmH 2 O in patients with a PaO 2 /FiO 2 ≤ 300 without intracranial hypertension (41% if PaO 2 /FiO 2 150-300 and 50% if PaO 2 /FiO 2 < 150) and 10 cmH 2 O in patients with intracranial hypertension (32% if PaO 2 /FiO 2 150-300 and 33% if PaO 2 /FiO 2 < 150). Regardless of the presence of intracranial hypertension, the most common carbon dioxide target remained 36-40 mmHg whereas the most common PaO 2 target was 81-100 mmHg in all the 3 scenarios. The most frequent rescue strategies utilized in case of refractory respiratory failure despite conventional ventilator settings were neuromuscular blocking agents [406 (88%)], recruitment manoeuvres [319 (69%)] and prone position [292 (63%)]. Conclusions: Ventilatory management, targets and practice of adult severe TBI patients with and without respiratory failure are widely different among centres. These findings may be helpful to define future investigations in this topic.

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Mechanical ventilation in neurocritical care patients: a systematic literature review

Cited by 78 publications

References 51 publications

Extra Corporeal Life Support in Traumatic Brain Injury Patients

Extra Corporeal Life Support in Traumatic Brain Injury Patients

Acute respiratory distress syndrome in traumatic brain injury: how do we manage it?

VENTILatOry strategies in patients with severe traumatic brain injury: the VENTILO Survey of the European Society of Intensive Care Medicine (ESICM)

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