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Neurocritical Care
Published in: Neurocritical Care 1/2023

07-09-2022 | Central Nervous System Trauma | Review Article

Mechanical Ventilation in Patients with Traumatic Brain Injury: Is it so Different?

Authors: Shaurya Taran, Sung-Min Cho, Robert D. Stevens

Published in: Neurocritical Care | Issue 1/2023

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Abstract

Patients with traumatic brain injury (TBI) frequently require invasive mechanical ventilation and admission to an intensive care unit. Ventilation of patients with TBI poses unique clinical challenges, and careful attention is required to ensure that the ventilatory strategy (including selection of appropriate tidal volume, plateau pressure, and positive end-expiratory pressure) does not cause significant additional injury to the brain and lungs. Selection of ventilatory targets may be guided by principles of lung protection but with careful attention to relevant intracranial effects. In patients with TBI and concomitant acute respiratory distress syndrome (ARDS), adjunctive strategies include sedation optimization, neuromuscular blockade, recruitment maneuvers, prone positioning, and extracorporeal life support. However, these approaches have been largely extrapolated from studies in patients with ARDS and without brain injury, with limited data in patients with TBI. This narrative review will summarize the existing evidence for mechanical ventilation in patients with TBI. Relevant literature in patients with ARDS will be summarized, and where available, direct data in the TBI population will be reviewed. Next, practical strategies to optimize the delivery of mechanical ventilation and determine readiness for extubation will be reviewed. Finally, future directions for research in this evolving clinical domain will be presented, with considerations for the design of studies to address relevant knowledge gaps.
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Metadata
Title
Mechanical Ventilation in Patients with Traumatic Brain Injury: Is it so Different?
Authors
Shaurya Taran
Sung-Min Cho
Robert D. Stevens
Publication date
07-09-2022
Publisher
Springer US
Published in
Neurocritical Care / Issue 1/2023
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-022-01593-1

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