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Ten False Beliefs About Mechanical Ventilation in Patients with Brain Injury

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Annual Update in Intensive Care and Emergency Medicine 2020

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

Abstract

Neurocritically ill patients often receive mechanical ventilation. The lung and the brain can affect each other, thus increasing the risk of develo** secondary damage, if not properly managed. Ventilator settings are not clear in this group of patients; traditionally, because of the risk of intracranial hypertension, high tidal volume and low levels of positive end-expiratory pressure (PEEP) are applied, whereas rescue strategies such as recruitment maneuvers, prone position, and extracorporeal membrane oxygenation (ECMO) are precluded. However, recent evidence is challenging these concepts. Findings in patients without acute respiratory distress syndrome (ARDS) suggest the application of lower tidal volumes (6 ml/kg predicted body weight [PBW]), in order to reduce the risk of develo** ventilator-induced lung injury (VILI) and boost the inflammatory response. PEEP is a key component of mechanical ventilation settings to guarantee alveolar recruitment and to enhance oxygen arterial saturation. It also improves brain tissue oxygen pressure without significantly affecting intracranial pressure or cerebral perfusion. Likewise, recruitment maneuvers should be taken into consideration as rescue treatment when appropriate. Preventive hyperventilation (carbon dioxide partial pressure [PaCO2] ≤25 mmHg) should be avoided. Tracheostomy is frequently performed in this group of patients; the ideal timing of tracheostomy is not clear yet although early tracheostomy seems to have some clinical advantages. In selected cases of severe respiratory failure, prone position and ECMO can also be taken into consideration. The aim of this chapter is to debulk ten false myths concerning ventilatory management in patients with brain injury.

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Author information

Authors and Affiliations

  1. Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy

    D. Battaglini & P. Pelosi

  2. Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy

    D. Battaglini, P. Pelosi & C. Robba

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  1. D. Battaglini
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  2. P. Pelosi
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  3. C. Robba
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Editors and Affiliations

  1. Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

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Battaglini, D., Pelosi, P., Robba, C. (2020). Ten False Beliefs About Mechanical Ventilation in Patients with Brain Injury. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2020. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-37323-8_34

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  • DOI: https://doi.org/10.1007/978-3-030-37323-8_34

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