Role of a successful spontaneous breathing trial in ventilator liberation in brain-injured patients

Shi, Zhonghua; Jonkman, Annemijn H.; Tuinman, Pieter R.; Chen, Guang-Qiang; Xu, Ming; Yang, Yanlin; Heunks, Leo; Zhou, Jianxin

doi:10.21037/atm-20-6407

Cited by 4 publications

(3 citation statements)

References 60 publications

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“…However, while interest in the use of partially supported breathing modes is increasing [ 118 , 119 ], the role of spontaneous breathing [ 120 ] ventilation in patients with ABI is less well-established [ 121 ]. Spontaneous respiratory effort has been shown to be beneficial by improving gas exchange and oxygenation, haemodynamics, and non-pulmonary organ function [ 10 , 106 , 122 – 124 ].…”

Section: Ventilatory Strategies In Acute Brain Injury: What Is Different?mentioning

confidence: 99%

Brain–lung interactions and mechanical ventilation in patients with isolated brain injury

Ziaka¹,

Exadaktylos

2021

Crit Care

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During the last decade, experimental and clinical studies have demonstrated that isolated acute brain injury (ABI) may cause severe dysfunction of peripheral extracranial organs and systems. Of all potential target organs and systems, the lung appears to be the most vulnerable to damage after brain injury (BI). The pathophysiology of these brain–lung interactions are complex and involve neurogenic pulmonary oedema, inflammation, neurodegeneration, neurotransmitters, immune suppression and dysfunction of the autonomic system. The systemic effects of inflammatory mediators in patients with BI create a systemic inflammatory environment that makes extracranial organs vulnerable to secondary procedures that enhance inflammation, such as mechanical ventilation (MV), surgery and infections. Indeed, previous studies have shown that in the presence of a systemic inflammatory environment, specific neurointensive care interventions—such as MV—may significantly contribute to the development of lung injury, regardless of the underlying mechanisms. Although current knowledge supports protective ventilation in patients with BI, it must be born in mind that ABI-related lung injury has distinct mechanisms that involve complex interactions between the brain and lungs. In this context, the role of extracerebral pathophysiology, especially in the lungs, has often been overlooked, as most physicians focus on intracranial injury and cerebral dysfunction. The present review aims to fill this gap by describing the pathophysiology of complications due to lung injuries in patients with a single ABI, and discusses the possible impact of MV in neurocritical care patients with normal lungs.

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Section: Ventilatory Strategies In Acute Brain Injury: What Is Different?mentioning

confidence: 99%

Brain–lung interactions and mechanical ventilation in patients with isolated brain injury

Ziaka¹,

Exadaktylos

2021

Crit Care

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“…1 ). We identified one additional study by citation searching, for 21 included studies (13, 14, 30–48). Additional study selection details are reported in eTables 1 and 2 (http://links.lww.com/CCM/H268).…”

Section: Resultsmentioning

confidence: 99%

Prognostic Factors Associated With Extubation Failure in Acutely Brain-Injured Patients: A Systematic Review and Meta-Analysis*

Taran

Angeloni

Pinto

et al. 2022

Critical Care Medicine

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Objective: Extubation failure in brain-injured patients is associated with increased morbidity. Our objective was to systematically review prognostic factors associated with extubation failure in acutely brain-injured adult patients receiving invasive ventilation in an ICU. Data Sources: MEDLINE, Embase, and Cochrane Central were searched from inception to January 31, 2022. Study Selection: Two reviewers independently screened citations and selected English-language cohort studies and randomized trials examining the association of prognostic factors with extubation failure. Studies were considered if they included greater than or equal to 80% adult patients with acute brain injury admitted to the ICU and mechanically ventilated for greater than or equal to 24 hours. Data Extraction: Two reviewers extracted data on population, prognostic factors, extubation outcomes, and risk of bias (using the quality in prognostic factors tool). Data Synthesis: In the primary analysis, adjusted odds ratios (aOR) for each prognostic factor were pooled using random-effects models. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. The search identified 7,626 citations, of which 21 studies met selection criteria. Moderate-certainty evidence suggested increased risk of extubation failure with older age (aOR, 3.0 for upper vs lower tertile; 95% CI, 1.78–5.07) and longer duration of mechanical ventilation (aOR, 3.47 for upper vs lower tertile; 95% CI, 1.68–7.19). Presence of cough (aOR, 0.40; 95% CI, 0.28–0.57) and intact swallow (aOR, 0.34; 95% CI, 0.21–0.54) probably decreased risk of extubation failure (moderate certainty). Associations of other factors with extubation failure were informed by low or very low certainty evidence. Conclusions: Patient age, duration of mechanical ventilation, and airway reflexes were associated with extubation failure in brain-injured patients with moderate certainty. Future studies are needed to determine the optimal application of these variables in clinical practice.

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“…En contraparte, Shi et al concluyen en su estudio que en pacientes con lesión cerebral la falla en la liberación del ventilador fue común después de una PVE exitosa (42). El análisis fisiológico en profundidad durante esta prueba no proporcionó datos para predecir la liberación exitosa en estos pacientes (42).…”

Section: ¿Qué Factores Se Asocian De Forma Independiente Al éXito De ...unclassified

Extubación en el paciente neurocrítico con lesiones encefálicas agudas: revisión narrativa de la literatura

Álvarez-Arango

González-Medina

Valencia-Valencia

et al. 2022

Iatreia

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Introducción: el destete ventilatorio (weaning) y la extubación en el paciente con lesiones encefálicas agudas es un desafío para el personal de salud ya que no hay un consenso claro sobre los criterios de extubación. Objetivo: resumir la evidencia disponible sobre la extubación del paciente con lesiones encefálicas agudas y analizar posibles alternativas a los criterios clásicos de extubación. Métodos: se realizó una búsqueda de la literatura médica, en los idiomas español e inglés, de los últimos 20 años en diferentes bases de datos. Se incluyeron revisiones sistemáticas con o sin metaanálisis, guías y recomendaciones de sociedades científicas, ensayos clínicos y estudios observacionales que cumplieran los criterios de inclusión. Resultados: se recolectaron 262 artículos de interés, de los cuales, mediante un análisis y comparación de la evidencia, se seleccionaron 48 artículos que tuvieron más relevancia para cumplir el objetivo planteado. Conclusiones: la evidencia disponible es débil a la hora de brindar una recomendación sobre los criterios de extubación en el paciente neurocrítico. Podría realizarse una extubación precoz con un nivel mínimo de conciencia, pero manteniendo los reflejos protectores de las vías respiratorias, sin tener aumento en la tasa de reintubación o mortalidad.

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Role of a successful spontaneous breathing trial in ventilator liberation in brain-injured patients

Cited by 4 publications

References 60 publications

Brain–lung interactions and mechanical ventilation in patients with isolated brain injury

Brain–lung interactions and mechanical ventilation in patients with isolated brain injury

Prognostic Factors Associated With Extubation Failure in Acutely Brain-Injured Patients: A Systematic Review and Meta-Analysis*

Extubación en el paciente neurocrítico con lesiones encefálicas agudas: revisión narrativa de la literatura

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