Combined lung and brain ultrasonography for an individualized “brain-protective ventilation strategy” in neurocritical care patients with challenging ventilation needs

Francesco Corradi, Chiara Robba, Guido Tavazzi, Gabriele Via

Research output: Contribution to journalArticle

Abstract

When intracranial hypertension and severe lung damage coexist in the same clinical scenario, their management poses a difficult challenge, especially as concerns mechanical ventilation management. The needs of combined lung and brain protection from secondary damage may conflict, as ventilation strategies commonly used in patients with ARDS are potentially associated with an increased risk of intracranial hypertension. In particular, the use of positive end-expiratory pressure, recruitment maneuvers, prone positioning, and protective lung ventilation can have undesirable effects on cerebral physiology: they may positively or negatively affect intracranial pressure, based on the final repercussions on PaO2 and cerebral perfusion pressure (through changes in cardiac output, mean arterial pressure, venous return, PaO2 and PaCO2), also according to the baseline conditions of cerebral autoregulation. Lung ultrasound (LUS) and brain ultrasound (BUS, as a combination of optic nerve sheath diameter assessment and cerebrovascular Doppler ultrasound) have independently proven their potential in respectively monitoring lung aeration and brain physiology at the bedside. In this narrative review, we describe how the combined use of LUS and BUS on neurocritical patients with demanding mechanical ventilation needs can contribute to ventilation management, with the aim of a tailored “brain-protective ventilation strategy.”

Original languageEnglish
Article number24
JournalCritical Ultrasound Journal
Volume10
Issue number1
DOIs
Publication statusPublished - Dec 1 2018

Keywords

  • ARDS
  • Brain injury
  • Brain ultrasound
  • Intracranial hypertension
  • Lung ultrasound
  • Mechanical ventilation
  • Neuro-critical care
  • Respiratory monitoring

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

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