Liberation from Mechanical Ventilation in Acutely Brain-injured Patients

2006 ◽  
pp. 486-493
Author(s):  
J. L. Y. Tsang ◽  
N. D. Ferguson
Keyword(s):  
Mechanical Ventilation ◽  
Brain Injured ◽  
Injured Patients

scholarly journals Mechanical ventilation in brain injured patients: seeing the forest for the trees

2017 ◽  
Vol 9 (10) ◽  
pp. 3483-3487
Author(s):  
Andrea Bruni ◽  
Eugenio Garofalo ◽  
Corrado Pelaia ◽  
Federico Longhini ◽  
Paolo Navalesi
Keyword(s):  
Mechanical Ventilation ◽  
Brain Injured ◽  
Injured Patients

scholarly journals Prevention of early ventilation-acquired pneumonia (VAP) in comatose brain-injured patients by a single dose of ceftriaxone: PROPHY-VAP study protocol, a multicentre, randomised, double-blind, placebo-controlled trial

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e021488 ◽  
Author(s):  
Claire Dahyot-Fizelier ◽  
Denis Frasca ◽  
Sigismond Lasocki ◽  
Karim Asehnoune ◽  
Dorothée Balayn ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Single Dose ◽  
Brain Injury ◽  
Tracheal Intubation ◽  
Early Onset ◽  
Adult Brain ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Brain Injured ◽  
Injured Patients

IntroductionVentilator-associated pneumonia (VAP) is the first cause of healthcare-associated infections in intensive care units (ICUs) and brain injury is one of the main risk factors for early-onset VAP. Antibiotic prophylaxis has been reported to decrease their occurrence in brain-injured patients, but a lack of controlled randomised trials and the risk of induction of bacterial resistance explain the low level of recommendations. The goal of this study is to determine whether a single dose of ceftriaxone within the 12 hours postintubation after severe brain injury can decrease the risk of early-onset VAP.Methods and analysisThe PROPHY-VAP is a French multicentre, randomised, double-blind, placebo-controlled, clinical trial. Adult brain-injured patients (n=320) with a Glasgow Coma Scale ≤12, requiring mechanical ventilation for more than 48 hours, are randomised to receive either a single dose of ceftriaxone 2 g or a placebo within the 12 hours after tracheal intubation. The primary endpoint is the proportion of patients developing VAP from the 2nd to the 7th day after mechanical ventilation. Secondary endpoints include the proportion of patients developing late VAP (>7 days after tracheal intubation), the number of ventilator-free days, VAP-free days and antibiotic-free days, length of stay in the ICU, proportion of patients with ventilator-associated events and mortality during their ICU stay.Ethics and disseminationThe initial research project was approved by the Institutional Review Board of OUEST III (France) on 20 October 2014 (registration No 2014-001668-36) and carried out according to the principles of the Declaration of Helsinki and the Clinical Trials Directive 2001/20/EC of the European Parliament relating to the Good Clinical Practice guidelines. The results of this study will be presented in national and international meetings and published in an international peer-reviewed journal.Trial registration numberNCT02265406; Pre-results.

scholarly journals Multicentre observational study on practice of ventilation in brain injured patients: the VENTIBRAIN study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047100
Author(s):  
Chiara Robba ◽  
Giuseppe Citerio ◽  
Fabio S Taccone ◽  
Stefania Galimberti ◽  
Paola Rebora ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Brain Injury ◽  
Observational Study ◽  
Annual Conference ◽  
Lung Protection ◽  
Arterial Blood ◽  
Brain Injured ◽  
Injured Patients ◽  
Ventilator Settings

IntroductionMechanical ventilatory is a crucial element of acute brain injured patients’ management. The ventilatory goals to ensure lung protection during acute respiratory failure may not be adequate in case of concomitant brain injury. Therefore, there are limited data from which physicians can draw conclusions regarding optimal ventilator management in this setting.Methods and analysisThis is an international multicentre prospective observational cohort study. The aim of the ‘multicentre observational study on practice of ventilation in brain injured patients’—the VENTIBRAIN study—is to describe the current practice of ventilator settings and mechanical ventilation in acute brain injured patients. Secondary objectives include the description of ventilator settings among different countries, and their association with outcomes. Inclusion criteria will be adult patients admitted to the intensive care unit (ICU) with a diagnosis of traumatic brain injury or cerebrovascular diseases (intracranial haemorrhage, subarachnoid haemorrhage, ischaemic stroke), requiring intubation and mechanical ventilation and admission to the ICU. Exclusion criteria will be the following: patients aged <18 years; pregnant patients; patients not intubated or not mechanically ventilated or receiving only non-invasive ventilation. Data related to clinical examination, neuromonitoring if available, ventilator settings and arterial blood gases will be recorded at admission and daily for the first 7 days and then at day 10 and 14. The Glasgow Outcome Scale Extended on mortality and neurological outcome will be collected at discharge from ICU, hospital and at 6 months follow-up.Ethics and disseminationThe study has been approved by the Ethic committee of Brianza at the Azienda Socio Sanitaria Territoriale-Monza. Data will be disseminated to the scientific community by abstracts submitted to the European Society of Intensive Care Medicine annual conference and by original articles submitted to peer-reviewed journals.Trial registration numberNCT04459884.

scholarly journals Lung Protective Ventilation in Brain-Injured Patients: Low Tidal Volumes or Airway Pressure Release Ventilation?

2020 ◽  
Author(s):  
Ravi Garg
Keyword(s):  
Mechanical Ventilation ◽  
Airway Pressure ◽  
Airway Pressure Release Ventilation ◽  
Lung Protective Ventilation ◽  
Mean Airway Pressure ◽  
Alternative Mode ◽  
Pressure Release ◽  
Brain Injured ◽  
Injured Patients ◽  
Pressure Release Ventilation

AbstractThe optimal mode of mechanical ventilation for lung protection is unknown in brain-injured patients as this population is excluded from large studies of lung protective mechanical ventilation. Survey results suggest that low tidal volume (LTV) ventilation is the favored mode likely due to the success of LTV in other patient populations. Airway pressure release ventilation (APRV) is an alternative mode of mechanical ventilation that may offer several benefits over LTV in this patient population. APRV is an inverse-ratio, pressure-controlled mode of mechanical ventilation that utilizes a higher mean airway pressure compared with LTV. This narrative review compares both modes of mechanical ventilation and their consequences in brain-injured patients. Fears that APRV may raise intracranial pressure by virtue of a higher mean airway pressure are not substantiated by the available evidence. Primarily by virtue of spontaneous breathing, APRV often results in improvement in systemic hemodynamics and thereby improvement in cerebral perfusion pressure. Compared with LTV, sedation requirements are lessened by APRV allowing for more accurate neuromonitoring. APRV also uses an open loop system supporting clearance of secretions throughout the respiratory cycle. Additionally, APRV avoids hypercapnic acidosis and oxygen toxicity that may be especially deleterious to the injured brain. Although high-level evidence is lacking that one mode of mechanical ventilation is superior to another in brain-injured patients, several aspects of APRV make it an appealing mode for select brain-injured patients.

Specific Computerized Attention Training in Stroke and Traumatic Brain-Injured Patients

2003 ◽  
Vol 14 (4) ◽  
pp. 283-292 ◽  
Author(s):  
W. Sturm ◽  
B. Fimm ◽  
A. Cantagallo ◽  
N. Cremel ◽  
P. North ◽  
...  
Keyword(s):  
Divided Attention ◽  
Single Case ◽  
Baseline Period ◽  
Specific Training ◽  
Attention Task ◽  
Baseline Phase ◽  
Computerized Training ◽  
Brain Injured ◽  
Divided Attention Task ◽  
Injured Patients

Abstract: In a multicenter European approach, the efficacy of the AIXTENT computerized training programs for intensity aspects (alertness and vigilance) and selectivity aspects (selective and divided attention) of attention was studied in 33 patients with brain damage of vascular and traumatic etiology. Each patient received training in one of two most impaired of the four attention domains. Control tests were performed by means of a standardized computerized attention test battery (TAP) comprising tests for the four attention functions. Assessment was carried out at the beginning and at the end of a four week baseline period and after the training period of 14 one-hour sessions. At the end of the baseline phase, there was only slight but significant improvement for the most complex attention function, divided attention (number of omissions). After the training, there were significant specific training effects for both intensity aspects (alertness and vigilance) and also for the number of omissions in the divided attention task. The application of inferential single case procedures revealed a high number of significant improvements in individual cases after specific training of alertness and vigilance problems. On the other hand, a non specific training addressing selectivity aspects of attention lead either to improvement or deterioration of alertness and vigilance performance. The results corroborate the findings of former studies with the same training instrument but in patients with different lesion etiologies.

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