Management and outcome of mechanically ventilated neurologic patients*

Pelosi, Paolo; Ferguson, Niall D.; Frutos‐Vivar, Fernando; Anzueto, Antonio; Putensen, Christian; Raymondos, Konstantinos; Apezteguía, Carlos; Desmery, Pablo; Hurtado, Javier; Abroug, Fékri; Elizalde, José; Tomicić, Vinko; Çakar, Nahit; González, Marco; Arabi, Yaseen M.; Moreno, Rui P.; Esteban, Andrés

doi:10.1097/ccm.0b013e31821209a8

Cited by 185 publications

(129 citation statements)

References 41 publications

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“…1 Compared with other critically ill populations, those with various forms of brain injury generally have worse outcomes. Apart from having a higher risk of death, those who survive are frequently left with various degrees of functional and cognitive limitations.…”

Section: Résumémentioning

confidence: 99%

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Kramer

Zygun

2013

Can J Anesth/J Can Anesth

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Section: Résumémentioning

confidence: 99%

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Kramer

Zygun

2013

Can J Anesth/J Can Anesth

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“…1.3 – 7.1% of all stroke patients are tracheotomized [8, 9] due to severe dysphagia with prolonged insufficient airway protection or the need for long-term ventilation [10]. The tracheostomy rate of stroke patients on the intensive care unit (ICU) is even higher and ranges between 14 – 35%, exceeding the tracheostomy rates of mixed ICU patient collectives which lie at 10 – 15% [10-12]. …”

Section: Introductionmentioning

confidence: 99%

Increase of Substance P Concentration in Saliva after Pharyngeal Electrical Stimulation in Severely Dysphagic Stroke Patients – an Indicator of Decannulation Success?

et al. 2017

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Background/Aims: Substance P (SP) is a neuropeptide, likely acting as a neurotransmitter in the pharyngeal mucosa enhancing the swallow and cough reflex. Pharyngeal Electrical Stimulation (PES) induces a temporary increase of salivary SP levels in healthy adults. Previous evidence suggests that post-stroke dysphagia is related to reduced SP levels. Here, we investigated the effects of PES on SP levels in severely dysphagic stroke patients and a possible link between increase of SP and treatment success. Methods: 23 tracheotomized stroke patients who could not be decannulated due to severe and persisting dysphagia according to endoscopic evaluation received PES for 10 minutes a day over three consecutive days in this prospective single-center study. If initial treatment failed, repetitive stimulation cycles were provided. Saliva samples were collected before and directly after each PES. Results: 61% of participants were decannulated after the first treatment cycle. Increase of SP levels post-stimulation was closely related to treatment success, i.e. decannulation with 79% of successfully treated patients showing increase of SP, whereas 89% of unsuccessfully treated patients had stable or decreased SP levels. Applying logistic regression analysis, increase of SP level remained the only independent predictor of decannulation after PES. All 3 repetitively treated patients showed increased SP levels when progressing from the 1^st to the 2^nd cycle, two of whom were decannulated hereafter. Conclusions: The physiological mechanism of PES may consist in restoration of sensory feedback, which is known to be crucial for the execution of a safe swallow. SP possibly acts as a biomarker for indicating response to PES.

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“…In this context, high volume ventilation may further exacerbate the pulmonary and systemic inflammatory response in brain-injured patients with ALI/ARDS, and hyperventilation for permissive hypocapnia may be associated with more lung injury [22]. In a large-scale observational study, it was noted that neurologic patients were ventilated with mean tidal volumes approximating a 9 ml/kg of predicted body weight [23]. Higher tidal volume has also been identified as a significant and modifiable risk factor for the development of ARDS in patients with neurological disorders [4,5].…”

Section: Discussionmentioning

confidence: 99%

Association between ventilatory settings and development of acute respiratory distress syndrome in mechanically ventilated patients due to brain injury

Tejerina

Pelosi

Muriel

et al. 2017

Journal of Critical Care

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a b s t r a c t a r t i c l e i n f oPurpose: In neurologically critically ill patients with mechanical ventilation (MV), the development of acute respiratory distress syndrome (ARDS) is a major contributor to morbidity and mortality, but the role of ventilatory management has been scarcely evaluated. We evaluate the association of tidal volume, level of PEEP and driving pressure with the development of ARDS in a population of patients with brain injury. Materials and methods: We performed a secondary analysis of a prospective, observational study on mechanical ventilation. Results: We included 986 patients mechanically ventilated due to an acute brain injury (hemorrhagic stroke, ischemic stroke or brain trauma). Incidence of ARDS in this cohort was 3%. Multivariate analysis suggested that driving pressure could be associated with the development of ARDS (odds ratio for unit increment of driving For personal use only. No other uses without permission. Copyright ©2017. Elsevier Inc. All rights reserved. pressure 1.12; confidence interval for 95%: 1.01 to 1.23) whereas we did not observe association for tidal volume (in ml per kg of predicted body weight) or level of PEEP. ARDS was associated with an increase in mortality, longer duration of mechanical ventilation, and longer ICU length of stay. Conclusions: In a cohort of brain-injured patients the development of ARDS was not common. Driving pressure was associated with the development of this disease.

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Management and outcome of mechanically ventilated neurologic patients*

Abstract: In our study, one of every five mechanically ventilated patients received this therapy as a result of a neurologic disease. This cohort of patients showed a higher mortality rate than nonneurologic patients despite a lower incidence of extracerebral organ dysfunction.

Cited by 185 publications

References 41 publications

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Increase of Substance P Concentration in Saliva after Pharyngeal Electrical Stimulation in Severely Dysphagic Stroke Patients – an Indicator of Decannulation Success?

Association between ventilatory settings and development of acute respiratory distress syndrome in mechanically ventilated patients due to brain injury

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