Respiratory Management in Patients with Severe Brain Injury

Asehnoune, Karim; Roquilly, Antoine; Cinotti, Raphaël

doi:10.1007/978-3-319-73670-9_41

Cited by 19 publications

(31 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In general, longer ventilation time augments the risk for both of the latter complications in neurocritical care patients [7,8]. However, rash extubation may cause complications such as blood pressure surges, aspiration and respiratory difficulties.…”

Section: Introductionmentioning

confidence: 99%

Ventilation time and prognosis after stroke thrombectomy: the shorter, the better!

Fandler‐Höfler

Heschl

Kneihsl

et al. 2020

Euro J of Neurology

View full text Add to dashboard Cite

Background and purpose The aim was to investigate the clinical impact of the duration of artificial ventilation in stroke patients receiving mechanical thrombectomy (MT) under general anaesthesia. Methods All consecutive ischaemic stroke patients who had been treated at our centre with MT for anterior circulation large vessel occlusion under general anaesthesia were identified over an 8‐year period. Ventilation time was analysed as a continuous variable and patients were grouped into extubation within 6 h (‘early’), 6–24 h (‘delayed’) and >24 h (‘late’). Favourable outcome was defined as modified Rankin Scale scores of 0–2 at 3 months post‐stroke. Pneumonia rate and reasons for prolonged ventilation were also assessed. Results Amongst 447 MT patients (mean age 69.1 ± 13.3 years, 50.1% female), the median ventilation time was 3 h. 188 (42.6%) patients had a favourable 3‐month outcome, which correlated with shorter ventilation time (Spearman’s rho 0.39, P < 0.001). In patients extubated within 24 h, early compared to delayed extubation was associated with improved outcome (odds ratio 2.40, 95% confidence interval 1.53–3.76, P < 0.001). This was confirmed in multivariable analysis (P = 0.01). A longer ventilation time was associated with a higher rate of pneumonia during neurointensive care unit/stroke unit stay (early/delayed/late extubation: 9.6%/20.6%/27.7%, P < 0.01). Whilst stroke‐associated complications represented the most common reasons for late extubation (>24 h), delayed extubation (6–24 h) was associated with admission outside of core working hours (P < 0.001). Conclusions Prolonged ventilation time after stroke thrombectomy independently predicts unfavourable outcome at 3 months and is associated with increased pneumonia rates. Therefore, extubation should be performed as early as safely possible.

show abstract

Section: Introductionmentioning

confidence: 99%

Ventilation time and prognosis after stroke thrombectomy: the shorter, the better!

Fandler‐Höfler

Heschl

Kneihsl

et al. 2020

Euro J of Neurology

View full text Add to dashboard Cite

show abstract

“…Follow-up and treatment of head trauma in the intensive care process are carried out according to standard head trauma protocols [4] . Accordingly, patients with GCS≥8 can be checked up on under oxygen-non-invasive mechanical ventilation without intubation with close follow-up, whereas GCS <8 patients are treated without operation or after mechanical ventilation and sedation.…”

Section: Discussionmentioning

confidence: 99%

Analysis Of The Adult Traumatic Brain Injury Patients, Experiences of Neurosurgery and Intensive Care Unit

Özgültekin¹

2020

Haydarpasa Numune Med J

View full text Add to dashboard Cite

Introduction: Traumatic brain injuries and intracranial bleeding are the most severe forms of traumatic injuries with a high probability of devastating prognosis. Secondary injuries of the brain, following the primary injury, are preventable, and transportation to and in the hospital; the interventions in the emergency department, operational procedures and intensive care (ICU) stay are all crucial for the prevention of the secondary insult to the injured brain. In this retrospective cohort study, we analyzed the traumatic brain injuries that were followed by the neurosurgical and intensive care departments together in ICU for the last two years. Methods: With the written permission of the hospital administration, the data in the Hospital Information System were examined. Fifty-six patients admitted to the ICU with the diagnosis of traumatic intracranial bleeding over the age of 18 were analyzed. GCS scores on admission and discharge from ICU were regarded as ≥8 (Good outcome) and <8 (Bad outcome), and patients' clinical measures were examined according to these groups. Results: Pupillary reflexes showed a statistically significant difference between the ≥8 and <8 patients on admission. Blood glucose levels were clinically higher in the GCS<8 group. On the analysis of the 17 patients whose GCS scores <8 (Bad outcome) on discharge, it was seen that 8 of them had GCS scores below 8 on admission. These patients had severe head trauma, multiple intracranial pathologies and underwent decompressive surgery besides the polytrauma of the whole body. Discussion and Conclusion: We found that patients who had polytrauma with high intracranial pressure that could not be controlled with the first-line therapies and undergoing decompressive surgery, and also the patients who had high glucose levels on admission (>200mg/dl) showed worse prognosis. Hospitals should have an algorithmic approach and periodic analysis of the performances to prevent those delicate patients from having secondary insults to the brain during the emergency interventions and after.

show abstract

“…[97][98][99] PEEP should be adjusted to maintain normoxemia. Brain-injured patients have demonstrated tolerance of moderate levels of PEEP [100][101][102] as have post-liver transplant patients. [77][78][79] However, the effects of PEEP have not been studied in acute liver failure, and there is evidence that it may decrease hepatic blood flow in animal models.…”

Section: Acute Liver Failurementioning

confidence: 99%

Acute Respiratory Failure and Pulmonary Complications in End-Stage Liver Disease

Qadir

Wang

Chang

2018

Semin Respir Crit Care Med

View full text Add to dashboard Cite

Acute respiratory failure has a high mortality in patients with end-stage liver disease (ESLD). These patients may develop acute respiratory failure for reasons specific to advanced liver disease, including hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax. They may also develop respiratory complications due to conditions seen in the general intensive care unit population to which ESLD patients are at higher risk, including infection, volume overload, and the acute respiratory distress syndrome. Management of these patients is complicated and multifaceted, and a comprehensive understanding of the etiologies and treatment of acute respiratory failure is critical in this high-risk patient population. This article reviews current evidence surrounding the prevalence, management, and complications of the various etiologies of acute respiratory failure in ESLD patients.

show abstract

Respiratory Management in Patients with Severe Brain Injury

Cited by 19 publications

References 37 publications

Ventilation time and prognosis after stroke thrombectomy: the shorter, the better!

Ventilation time and prognosis after stroke thrombectomy: the shorter, the better!

Analysis Of The Adult Traumatic Brain Injury Patients, Experiences of Neurosurgery and Intensive Care Unit

Acute Respiratory Failure and Pulmonary Complications in End-Stage Liver Disease

Contact Info

Product

Resources

About