Abstract
Mechanical ventilation is a cornerstone in the management of patients with brain injury, since these patients are often unable to protect airways and they require a careful management of oxygenation and carbon dioxide. In addition, patients with brain injury are more susceptible to acute lung injury and respiratory complications compared to the general critically ill population. The primary aim of mechanical ventilation in these patients is to optimize gas exchange without promoting secondary brain injury (i.e. brain ischemia, further increase of intracranial pressure). However, mechanical ventilation and the current strategies of lung protective ventilation can negatively impact brain physiology, hemodynamics and worsen cerebral injury.
Understanding the brain and lung cross-talk is pivotal to adequately manage ventilatory support in these patients. Currently, daily practice is based more on physiological assumptions than scientific evidence which are currently lacking.
In this chapter we will review the main aspects of mechanical ventilation in these patients such as indications for intubation or non-invasive ventilation, ventilatory settings, rescue therapies, and weaning.
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Peluso, L., Bogossian, E., Robba, C. (2022). Mechanical Ventilation in Brain Injured Patients. In: Bellani, G. (eds) Mechanical Ventilation from Pathophysiology to Clinical Evidence. Springer, Cham. https://doi.org/10.1007/978-3-030-93401-9_18
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DOI: https://doi.org/10.1007/978-3-030-93401-9_18
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