TY - JOUR
T1 - Mechanical ventilation in neurocritical care setting: A clinical approach
AU - Battaglini, Denise
AU - Siwicka Gieroba, Dorota
AU - Brunetti, Iole
AU - Patroniti, Nicolò
AU - Bonatti, Giulia
AU - Rocco, Patricia Rieken Macedo
AU - Pelosi, Paolo
AU - Robba, Chiara
PY - 2020
Y1 - 2020
N2 - Neuropatients often require invasive mechanical ventilation (MV). Ideal ventilator settings and respiratory targets in neuro patients are unclear. Current knowledge suggests maintaining protective tidal volumes of 6–8 ml/kg of predicted body weight in neuropatients. This approach may reduce the rate of pulmonary complications, although it cannot be easily applied in a neuro setting due to the need for special care to minimize the risk of secondary brain damage. Additionally, the weaning process from MV is particularly challenging in these patients who cannot control the brain respiratory patterns and protect airways from aspiration. Indeed, extubation failure in neuropatients is very high, while tracheostomy is needed in one-third of the patients. The aim of this manuscript is to review and describe the current management of invasive MV, weaning, and tracheostomy for the main four subpopulations of neuro patients: traumatic brain injury, acute ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage.
AB - Neuropatients often require invasive mechanical ventilation (MV). Ideal ventilator settings and respiratory targets in neuro patients are unclear. Current knowledge suggests maintaining protective tidal volumes of 6–8 ml/kg of predicted body weight in neuropatients. This approach may reduce the rate of pulmonary complications, although it cannot be easily applied in a neuro setting due to the need for special care to minimize the risk of secondary brain damage. Additionally, the weaning process from MV is particularly challenging in these patients who cannot control the brain respiratory patterns and protect airways from aspiration. Indeed, extubation failure in neuropatients is very high, while tracheostomy is needed in one-third of the patients. The aim of this manuscript is to review and describe the current management of invasive MV, weaning, and tracheostomy for the main four subpopulations of neuro patients: traumatic brain injury, acute ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage.
KW - acute brain injury
KW - mechanical ventilation
KW - neurocritical care
KW - tracheostomy
KW - weaning
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U2 - 10.1016/j.bpa.2020.09.001
DO - 10.1016/j.bpa.2020.09.001
M3 - Review article
AN - SCOPUS:85091680869
JO - Best Practice and Research in Clinical Anaesthesiology
JF - Best Practice and Research in Clinical Anaesthesiology
SN - 1753-3740
ER -