Emergency Neurological Life Support: Airway, Ventilation, and Sedation

Abstract

Airway management and ventilation are central to the resuscitation of the neurologically ill. These patients often have evolving processes that threaten the airway and adequate ventilation. Furthermore, intubation, ventilation, and sedative choices directly affect brain perfusion. Therefore, airway, ventilation, and sedation was chosen as an emergency neurological life support protocol. Topics include airway management, when and how to intubate with special attention to hemodynamics and preservation of cerebral blood flow, mechanical ventilation settings, and the use of sedative agents based on the patient's neurological status.

Significance of arterial hyperoxia and relationship with case fatality in traumatic brain injury: a multicentre cohort study

“…Beyond avoiding hypoxia, no recommendation currently exists to guide an oxygenation strategy in ventilated TBI patients 37. Common sense would call for avoidance of unnecessary arterial hyperoxia and a controlled re-oxygenation strategy targeting normal saturation and PaO 2 levels 37. However, our study finds that the prevalence of hyperoxia upon admission to ICU in our studied population of ventilated TBI patients was as high as one in five patients.…”

“…To this end, the results of our study may have potential implications for current clinical practice and future research. Beyond avoiding hypoxia, no recommendation currently exists to guide an oxygenation strategy in ventilated TBI patients 37. Common sense would call for avoidance of unnecessary arterial hyperoxia and a controlled re-oxygenation strategy targeting normal saturation and PaO 2 levels 37.…”

Recommendations for the Management of Cerebral and Cerebellar Infarction With Swelling

“…86 There is no evidence that depolarizing agents or fentanyl, lidocaine, and propofol are deleterious to the patient. After intubation, the Paco 2 should be corrected to normocapnia.…”

Status Epilepticus in Adults: A Review of Diagnosis and Treatment

“…The most popular is fosphenytoin/phenytoin. 23 Phenytoin is administered at a dose of 20 mg/kg at a rate not to exceed 50 mg/min. Fosphenytoin is a prodrug of phenytoin that has no pharmacological activity before its in vivo conversion to phenytoin.…”