Ventilation in Trauma Patients: The First 24 h is Different!

Hardcastle, Timothy Craig; Muckart, D. J. J.; Maier, Ronald V.

doi:10.1007/s00268-016-3530-1

Cited by 14 publications

(19 citation statements)

References 49 publications

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“…It is unfortunate that—due to the different pathophysiological mechanisms of ALI and safety issues—most important trials of lung protective ventilation exclude patients with ABI. Nevertheless, some studies have reported that ventilation with low VT achieves better neurophysiological protection and that this is associated with a lower incidence of ALI in critically ill neurological patients [ 13 , 95 , 96 ], although it still debated whether the protective ventilation strategy should be extrapolated to the prehospital and emergency environment during the acute resuscitative phase (12–24 h) [ 97 ]. Despite the lack of robust evidence, the recent recommendations of the European Society of ICM state that there is a consensus that the optimal range of PaCO 2 lies between 35–45 mmHg [ 91 ].…”

Section: Ventilatory Strategies In Acute Brain Injury: What Is Different?mentioning

confidence: 99%

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: Ventilatory Strategies In Acute Brain Injury: What Is Different?mentioning

confidence: 99%

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

Ziaka¹,

Exadaktylos

2021

Crit Care

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“…Deviations in PaCO 2 values are tolerated in some trauma scenarios (mainly as part of lung-protective ventilation strategies), but PaCO 2 abnormalities have been shown to impose a major risk to an injured brain, and thus should be avoided in the acute phase following TBI [ 16 , 45 , 46 ]. These alterations can result either from trauma, or they can be iatrogenic in intubated and mechanically ventilated patients.…”

Section: Perioperative Cardiorespiratory Optimizationmentioning

confidence: 99%

“…Utilization of simultaneous multisystem surgery (SMS) is gradually becoming recognized as a useful tool in this context [ 12 , 13 , 14 ]. Some of the treatments utilized to manage polytrauma patients without TBI, including those of the damage control surgery (DCS) and the damage control resuscitation (DCR), are contraindicated when TBI is present, and can impose an additional risk to a patient’s survival and functional outcome [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Perioperative Management of Polytrauma Patients with Severe Traumatic Brain Injury Undergoing Emergency Extracranial Surgery: A Narrative Review

Picetti

Rosenstein

Balogh

et al. 2021

JCM

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Managing the acute phase after a severe traumatic brain injury (TBI) with polytrauma represents a challenging situation for every trauma team member. A worldwide variability in the management of these complex patients has been reported in recent studies. Moreover, limited evidence regarding this topic is available, mainly due to the lack of well-designed studies. Anesthesiologists, as trauma team members, should be familiar with all the issues related to the management of these patients. In this narrative review, we summarize the available evidence in this setting, focusing on perioperative brain protection, cardiorespiratory optimization, and preservation of the coagulative function. An overview on simultaneous multisystem surgery (SMS) is also presented.

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“…Ventilatory strategies in trauma patients could take into account the phase of treatment and the underlying injuries [45].…”

Section: Rescue Strategies For Refractory Respiratory Failurementioning

confidence: 99%

VENTILatOry strategies in patients with severe traumatic brain injury: the VENTILO Survey of the European Society of Intensive Care Medicine (ESICM)

Picetti

Pelosi²,

Taccone

et al. 2020

Crit Care

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Background: Severe traumatic brain injury (TBI) patients often develop acute respiratory failure. Optimal ventilator strategies in this setting are not well established. We performed an international survey to investigate the practice in the ventilatory management of TBI patients with and without respiratory failure.Methods: An electronic questionnaire, including 38 items and 3 different clinical scenarios [arterial partial pressure of oxygen (PaO 2 )/inspired fraction of oxygen (FiO 2 ) > 300 (scenario 1), 150-300 (scenario 2), < 150 (scenario 3)], was available on the European Society of Intensive Care Medicine (ESICM) website between November 2018 and March 2019. The survey was endorsed by ESICM. Results: There were 687 respondents [472 (69%) from Europe], mainly intensivists [328 (48%)] and anesthesiologists [206 (30%)]. A standard protocol for mechanical ventilation in TBI patients was utilized by 277 (40%) respondents and a specific weaning protocol by 198 (30%). The most common tidal volume (TV) applied was 6-8 ml/kg of predicted body weight (PBW) in scenarios 1-2 (72% PaO 2 /FIO 2 > 300 and 61% PaO 2 /FiO 2 150-300) and 4-6 ml/kg/ PBW in scenario 3 (53% PaO 2 /FiO 2 < 150). The most common level of highest positive end-expiratory pressure (PEEP) used was 15 cmH 2 O in patients with a PaO 2 /FiO 2 ≤ 300 without intracranial hypertension (41% if PaO 2 /FiO 2 150-300 and 50% if PaO 2 /FiO 2 < 150) and 10 cmH 2 O in patients with intracranial hypertension (32% if PaO 2 /FiO 2 150-300 and 33% if PaO 2 /FiO 2 < 150). Regardless of the presence of intracranial hypertension, the most common carbon dioxide target remained 36-40 mmHg whereas the most common PaO 2 target was 81-100 mmHg in all the 3 scenarios. The most frequent rescue strategies utilized in case of refractory respiratory failure despite conventional ventilator settings were neuromuscular blocking agents [406 (88%)], recruitment manoeuvres [319 (69%)] and prone position [292 (63%)]. Conclusions: Ventilatory management, targets and practice of adult severe TBI patients with and without respiratory failure are widely different among centres. These findings may be helpful to define future investigations in this topic.

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Ventilation in Trauma Patients: The First 24 h is Different!

Cited by 14 publications

References 49 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

Perioperative Management of Polytrauma Patients with Severe Traumatic Brain Injury Undergoing Emergency Extracranial Surgery: A Narrative Review

VENTILatOry strategies in patients with severe traumatic brain injury: the VENTILO Survey of the European Society of Intensive Care Medicine (ESICM)

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