Ventilatory strategies for patients with acute brain injury

Young, Neil; Rhodes, Jonathan; Mascia, Luciana; Andrews, Peter

doi:10.1097/mcc.0b013e32833546fa

Cited by 41 publications

(28 citation statements)

References 80 publications

(56 reference statements)

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“…If contemplating its use in patients with TBI, other rescue strategies should also be considered. Prone positioning, nitric oxide, and extracorporeal techniques (including arteriovenous extracorporeal membrane carbon dioxide removal and extracorporeal membrane oxygenation) have all been attempted in patients with concurrent ARDS and TBI [7]. These therapies all have their specific risks in patients with TBI: prone positioning may be particularly hazardous in patients with frontal injuries; the effects of nitric oxide on cerebral perfusion have not been fully elucidated; extracorporeal techniques usually rely on a degree of circuit heparinisation which may be hazardous in TBI.…”

Section: Discussionmentioning

confidence: 99%

“…Achieving these oxygenation and PaCO 2 targets in patients who have aspirated, or are developing an acute lung injury (ALI), acute respiratory distress syndrome (ARDS), or a ventilator-associated pneumonia, are likely to result in a conflict with what is now considered best practice in lung protective ventilation [4][5][6][7]. Blood pressure support to achieve CPP targets has been associated with the development of ARDS and is another source of conflict [5].…”

Section: Introductionmentioning

confidence: 99%

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High-Frequency Oscillation as a Rescue Strategy for Brain-Injured Adult Patients with Acute Lung Injury and Acute Respiratory Distress Syndrome

Young

Andrews

2011

Neurocrit Care

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Acute lung injury and acute respiratory distress syndrome (ARDS) occur frequently in brain-injured patients. Single organ dysfunction ventilator strategies result in a conflict between lung protective ventilation and the prevention of secondary neurological insult(s). The objectives of this study were to determine if clinical and physiological benefits of high-frequency oscillatory ventilation (HFOV) exist compared to conventional ventilation and to determine what data there are on the effects of HFOV on cerebral perfusion pressure and intracranial pressure. Systematic review was designed. An optimally sensitive search strategy was used that included; OVID MEDLINE, OVID EMBASE, Cochrane Clinical Trials Register, and hand searching of references of retrieved articles and proceedings of meetings. Study selection includes published randomized controlled trials comparing HFOV with conventional ventilation in adults with ARDS and observational studies of the use of HFOV in adults with ARDS and traumatic brain injury (TBI). Both authors reviewed all trials. A data extraction form was used. In adults with ARDS no mortality benefit has been shown with HFOV, oxygenation improves, arterial partial pressure of CO(2) may increase and there is no change in mean arterial blood pressure. There are few data describing HFOV in adults with TBI. In the small, low quality, studies that have been reported there have not been uncontrollable changes in intracranial pressure. HFOV has not been shown to have any mortality benefit in adults with ARDS. There are insufficient data to clarify the role, or safety, of HFOV in adults with TBI and concurrent ARDS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High-Frequency Oscillation as a Rescue Strategy for Brain-Injured Adult Patients with Acute Lung Injury and Acute Respiratory Distress Syndrome

Young

Andrews

2011

Neurocrit Care

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“…Hypoxia (PaO 2 <60 and/ or SaO 2 <90) is associated with poor neurologic outcomes in patients with acute brain injuries (Young et al 2010). The duration of hypoxia itself is an independent predictor of mortality (Jones et al 1994).…”

Section: Respiratory Supportmentioning

confidence: 99%

Neuro Critical Care

Majumdar¹

2012

Explicative Cases of Controversial Issues in Neurosurgery

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“…A few studies have looked at this in animal and the results suggest that an increased PEEP can be safely administered as long as the PEEP does not exceed the ICP. [85][86][87] However, the interaction between lung-protective strategies and brain tissue oxygen has not been thoroughly explored. As the above-mentioned paper by Rosenthal et al 83 suggests, poor lung function is bad for brain tissue oxygen.…”

Section: Lung-protective Strategies and Brain Tissue Oxygenmentioning

confidence: 99%

Brain Tissue Oxygen Monitoring and the Intersection of Brain and Lung: A Comprehensive Review

2016

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SummaryTraumatic brain injury is a problem that affects millions of Americans yearly and for which there is no definitive treatment that improves outcome. Continuous brain tissue oxygen (P btO 2 ) monitoring is a complement to traditional brain monitoring techniques, such as intracranial pressure and cerebral perfusion pressure. P btO 2 monitoring has not yet become a clinical standard of care, due to several unresolved questions. In this review, we discuss the rationale and technology of P btO 2 monitoring. We review the literature, both historic and current, and show that continuous P btO 2 monitoring is feasible and useful in patient management. P btO 2 numbers reflect cerebral blood flow and oxygen diffusion. Thus, continuous monitoring of P btO 2 yields important information about both the brain and the lung. The preclinical and clinical studies demonstrating these findings are discussed. In this review, we demonstrate that patient management in a P btO 2 -directed fashion is not the sole answer to the problem of treating traumatic brain injury but is an important adjunct to the armamentarium of multimodal neuromonitoring.

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Ventilatory strategies for patients with acute brain injury

Cited by 41 publications

References 80 publications

High-Frequency Oscillation as a Rescue Strategy for Brain-Injured Adult Patients with Acute Lung Injury and Acute Respiratory Distress Syndrome

High-Frequency Oscillation as a Rescue Strategy for Brain-Injured Adult Patients with Acute Lung Injury and Acute Respiratory Distress Syndrome

Neuro Critical Care

Brain Tissue Oxygen Monitoring and the Intersection of Brain and Lung: A Comprehensive Review

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