Neurologic Injury and Mechanical Ventilation

Nyquist, Paul; Stevens, Robert; Mirski, Marek A.

doi:10.1007/s12028-008-9130-7

Cited by 47 publications

(22 citation statements)

References 43 publications

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“…Furthermore, deep, superficial, or irregular breaths were excluded from the measurements and, to reduce the measurement errors, every recording was performed three times and averaged. Finally, we did not include acutely brain-injured patients as these patients usually fail due to airway compromise rather than respiratory mechanics [ 54 ]. D-RSBI may not be generalizable to this patient population.…”

Section: Discussionmentioning

confidence: 99%

Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index

et al. 2016

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BackgroundThe rapid shallow breathing index (RSBI), which is the ratio between respiratory rate (RR) and tidal volume (VT), is one of the most widely used indices to predict weaning outcome. Whereas the diaphragm plays a fundamental role in generating VT, in the case of diaphragmatic dysfunction the inspiratory accessory muscles may contribute. If this occurs during a weaning trial, delayed weaning failure is likely since the accessory muscles are more fatigable than the diaphragm. Hence, we hypothesised that the traditional RSBI could be implemented by substituting VT with the ultrasonographic evaluation of diaphragmatic displacement (DD). We named the new index the diaphragmatic-RSBI (D-RSBI). The aim of this study was to compare the ability of the traditional RSBI and D-RSBI to predict weaning failure in ready-to-wean patients.MethodsWe performed a prospective observational study. During a T-tube spontaneous breathing trial (SBT) we simultaneously evaluated right hemidiaphragm displacement (i.e., DD) by using M-mode ultrasonography as well as the RSBI. Outcome of the weaning attempt, length of mechanical ventilation, length of intensive care unit and hospital stay, and hospital mortality were recorded. Receiver operator characteristic (ROC) curves were used to evaluate the diagnostic accuracy of D-RSBI and RSBI.ResultsWe enrolled 51 patients requiring mechanical ventilation for more than 48 h who were ready to perform a SBT. Most of the patients, 34 (66 %), were successfully weaned from mechanical ventilation. When considering the 17 patients that failed the weaning attempt, 11 (64 %) had to be reconnected to the ventilator during the SBT, three (18 %) had to be re-intubated within 48 h of extubation, and three (18 %) required non-invasive ventilation support within 48 h of extubation. The areas under the ROC curves for D-RSBI and RSBI were 0.89 and 0.72, respectively (P = 0.006).ConclusionsD-RSBI (RR/DD) was more accurate than traditional RSBI (RR/VT) in predicting the weaning outcome.Trial registrationOur clinical trial was retrospectively registered with ClinicalTrials.gov (identifier: NCT02696018). ClinicalTrials.gov processed our record on 25 February 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1479-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index

et al. 2016

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“…There are tight interactions between cerebral and respiratory dynamics, so mechanical ventilation can have effect on cerebral perfusion and represent a potential burden for iatrogenic secondary brain damage (10). ARDS is common in neurocritical care patients (11)(12)(13) and lung injury is associated with worse outcome (12) and longer ICU length of stay (14).…”

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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“…Current practice guidelines for ventilatory management advocate protective lung strategies to prevent volutrauma, barotrauma, atelectrauma and biotrauma (3)(4)(5) . The principles are to use low tidal volumes (Vt) (5-6 ml/kg ideal body weight), maintenance of low mean airway pressures ≤ 30 cmH2O, judicious use of positive end-expiratory pressure (PEEP) with ∆ pressure ≤ 18 cmH2O, higher respiratory rates and permissive hypercapnia.…”

Section: Mechanical Ventilatory Strategies (2) : Conventional Ventilamentioning

confidence: 99%

Intensive Care Management of the Traumatic Brain Injury

Tülin¹,

Nihan²

2012

Emergency Medicine - An International Perspective

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Neurologic Injury and Mechanical Ventilation

Cited by 47 publications

References 43 publications

Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index

Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index

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

Intensive Care Management of the Traumatic Brain Injury

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