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01-12-2020 | Intracranial Hypertension | Conference Reports and Expert Panel

Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus

Authors: Chiara Robba, Daniele Poole, Molly McNett, Karim Asehnoune, Julian Bösel, Nicolas Bruder, Arturo Chieregato, Raphael Cinotti, Jacques Duranteau, Sharon Einav, Ari Ercole, Niall Ferguson, Claude Guerin, Ilias I. Siempos, Pedro Kurtz, Nicole P. Juffermans, Jordi Mancebo, Luciana Mascia, Victoria McCredie, Nicolas Nin, Mauro Oddo, Paolo Pelosi, Alejandro A. Rabinstein, Ary Serpa Neto, David B. Seder, Markus B. Skrifvars, Jose I. Suarez, Fabio Silvio Taccone, Mathieu van der Jagt, Giuseppe Citerio, Robert D. Stevens

Published in: Intensive Care Medicine | Issue 12/2020

Abstract

Purpose

To provide clinical practice recommendations and generate a research agenda on mechanical ventilation and respiratory support in patients with acute brain injury (ABI).

Methods

An international consensus panel was convened including 29 clinician-scientists in intensive care medicine with expertise in acute respiratory failure, neurointensive care, or both, and two non-voting methodologists. The panel was divided into seven subgroups, each addressing a predefined clinical practice domain relevant to patients admitted to the intensive care unit (ICU) with ABI, defined as acute traumatic brain or cerebrovascular injury. The panel conducted systematic searches and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to evaluate evidence and formulate questions. A modified Delphi process was implemented with four rounds of voting in which panellists were asked to respond to questions (rounds 1–3) and then recommendation statements (final round). Strong recommendation, weak recommendation, or no recommendation were defined when > 85%, 75–85%, and < 75% of panellists, respectively, agreed with a statement.

Results

The GRADE rating was low, very low, or absent across domains. The consensus produced 36 statements (19 strong recommendations, 6 weak recommendations, 11 no recommendation) regarding airway management, non-invasive respiratory support, strategies for mechanical ventilation, rescue interventions for respiratory failure, ventilator liberation, and tracheostomy in brain-injured patients. Several knowledge gaps were identified to inform future research efforts.

Conclusions

This consensus provides guidance for the care of patients admitted to the ICU with ABI. Evidence was generally insufficient or lacking, and research is needed to demonstrate the feasibility, safety, and efficacy of different management approaches.

Available only for authorised users

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Title: Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus
Authors: Chiara Robba
Daniele Poole
Molly McNett
Karim Asehnoune
Julian Bösel
Nicolas Bruder
Arturo Chieregato
Raphael Cinotti
Jacques Duranteau
Sharon Einav
Ari Ercole
Niall Ferguson
Claude Guerin
Ilias I. Siempos
Pedro Kurtz
Nicole P. Juffermans
Jordi Mancebo
Luciana Mascia
Victoria McCredie
Nicolas Nin
Mauro Oddo
Paolo Pelosi
Alejandro A. Rabinstein
Ary Serpa Neto
David B. Seder
Markus B. Skrifvars
Jose I. Suarez
Fabio Silvio Taccone
Mathieu van der Jagt
Giuseppe Citerio
Robert D. Stevens
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Intracranial Hypertension
Care
Acute Respiratory Distress-Syndrome
Tracheostomy
Published in: Intensive Care Medicine / Issue 12/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06283-0

At a glance: The STEP trials

Springer Medicine

Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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