Lung-Protective Ventilation for SAH Patients: Are These Measures Truly Protective?

Kapinos, Gregory; Chichra, Astha

doi:10.1007/s12028-014-0058-9

Cited by 2 publications

(3 citation statements)

References 12 publications

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“…For patients with GCS less than 9, the reported incidences were between 20 and 30% [ 13 , 49 – 51 ]. ALI and ARDS have been reported in 15–40% of patients suffering from an SAH [ 52 ], while the equivalent incidence for isolated TBI has been found to be about 20–25% [ 31 , 47 ].…”

Section: Lung Injuries In Acute Brain Damagementioning

confidence: 99%

“…Moreover, administration of vasoactive agents, a history of drug abuse, and hypertension have been described as additional risk parameters for the development of acute respiratory failure [ 7 , 47 ]. Finally, predictors of the development of ALI include older age, cardiac arrest, heart failure, chronic obstructive pulmonary disease, cardiovascular, renal or haematological dysfunction [ 55 ], sepsis, shock, transfusions, and pneumonia [ 52 ].…”

Section: Lung Injuries In Acute Brain Damagementioning

confidence: 99%

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Brain–lung interactions and mechanical ventilation in patients with isolated brain injury

Ziaka¹,

Exadaktylos

2021

Crit Care

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During the last decade, experimental and clinical studies have demonstrated that isolated acute brain injury (ABI) may cause severe dysfunction of peripheral extracranial organs and systems. Of all potential target organs and systems, the lung appears to be the most vulnerable to damage after brain injury (BI). The pathophysiology of these brain–lung interactions are complex and involve neurogenic pulmonary oedema, inflammation, neurodegeneration, neurotransmitters, immune suppression and dysfunction of the autonomic system. The systemic effects of inflammatory mediators in patients with BI create a systemic inflammatory environment that makes extracranial organs vulnerable to secondary procedures that enhance inflammation, such as mechanical ventilation (MV), surgery and infections. Indeed, previous studies have shown that in the presence of a systemic inflammatory environment, specific neurointensive care interventions—such as MV—may significantly contribute to the development of lung injury, regardless of the underlying mechanisms. Although current knowledge supports protective ventilation in patients with BI, it must be born in mind that ABI-related lung injury has distinct mechanisms that involve complex interactions between the brain and lungs. In this context, the role of extracerebral pathophysiology, especially in the lungs, has often been overlooked, as most physicians focus on intracranial injury and cerebral dysfunction. The present review aims to fill this gap by describing the pathophysiology of complications due to lung injuries in patients with a single ABI, and discusses the possible impact of MV in neurocritical care patients with normal lungs.

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Section: Lung Injuries In Acute Brain Damagementioning

confidence: 99%

Section: Lung Injuries In Acute Brain Damagementioning

confidence: 99%

Brain–lung interactions and mechanical ventilation in patients with isolated brain injury

Ziaka¹,

Exadaktylos

2021

Crit Care

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“…The hypothesized pathophysiology leading to the development of lung injury in aSAH patients is a “double-hit” model, with the first hit being an adrenergic surge and systemic inflammation incited by acute neurologic injury and the second from non-neurological stressors, such as infections, transfusions, and MV [ 21 – 23 ]. The best evidence for MV strategies to improve survival in ARDS involves lung-protective ventilation parameters described in an ARDS Network trial (ARDSNet) which includes tidal volumes of 6–8 mL/kg of predicted body weight to achieve a plateau pressure ≤ 30 cmH 2 O [ 24 ].…”

Section: Acute Respiratory Distress Syndrome In Asahmentioning

confidence: 99%

Mechanical ventilation in aneurysmal subarachnoid hemorrhage: systematic review and recommendations

et al. 2020

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Objective Mechanical ventilation (MV) has a complex interplay with the pathophysiology of aneurysmal subarachnoid hemorrhage (aSAH). We aim to provide a review of the physiology of MV in patients with aSAH, give recommendations based on a systematic review of the literature, and highlight areas that still need investigation. Data sources PubMed was queried for publications with the Medical Subject Headings (MeSH) terms “mechanical ventilation” and “aneurysmal subarachnoid hemorrhage” published between January 1, 1990, and March 1, 2020. Bibliographies of returned articles were reviewed for additional publications of interest. Study selection Study inclusion criteria included English language manuscripts with the study population being aSAH patients and the exposure being MV. Eligible studies included randomized controlled trials, observational trials, retrospective trials, case-control studies, case reports, or physiologic studies. Topics and articles excluded included review articles, pediatric populations, non-aneurysmal etiologies of subarachnoid hemorrhage, mycotic and traumatic subarachnoid hemorrhage, and articles regarding tracheostomies. Data extraction Articles were reviewed by one team member, and interpretation was verified by a second team member. Data synthesis Thirty-one articles met the inclusion criteria for this review. Conclusions We make recommendations on oxygenation, hypercapnia, PEEP, APRV, ARDS, and intracranial pressure monitoring.

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Lung-Protective Ventilation for SAH Patients: Are These Measures Truly Protective?

Cited by 2 publications

References 12 publications

Brain–lung interactions and mechanical ventilation in patients with isolated brain injury

Brain–lung interactions and mechanical ventilation in patients with isolated brain injury

Mechanical ventilation in aneurysmal subarachnoid hemorrhage: systematic review and recommendations

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