Mechanical Ventilation of Severe Traumatic Brain Injury Patients in the Prehospital Setting

Traumatic brain injury is the most common group of injuries among victims admitted to the emergency departments. Up to 20 % of individuals with brain damage require endotracheal intubation and mechanical ventilation, the duration of which is significantly longer than in non-neurological patients. Such patients have a higher incidence of acute respiratory distress syndrome and ventilator-associated pneumonia, and weaning and extubation are associated with significant difficulties. However, patients with traumatic brain injury are often excluded from randomized trials, and international guidelines for the treatment of severe traumatic brain injury do not provide clear ventilation strategies. Analysis of the literature allowed us to identify modern principles of respiratory support in severe traumatic brain injury, which include: tracheal intubation in Glasgow coma scale score of ≤ 8 points; early mechanical ventilation; PaO2 in the range of 80–120 mm Hg (SaO2 ≥ 95 %), PaCO2 — 35–45 mm Hg; tidal volume ≤ 8 ml/kg; respiratory rate ≈ 20/min; PEEP ≥ 5 cm H2O; head elevation by 30°; sedation in poor synchronization with the respirator; weaning from the respirator through the use of support ventilation modes; extubation when reaching 3 points on the VISAGE scale; early (up to 4 days) tracheostomy in predicted extubation failure.

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The priorities of early tracheotomy in patients with severe traumatic brain injury, in prolonged mechanical ventilation

10.26226/morressier.58f5b032d462b80296c9d6a2 ◽

2017 ◽

Author(s):

Mihal Kerci

Keyword(s):

Traumatic Brain Injury ◽

Mechanical Ventilation ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Prolonged Mechanical Ventilation ◽

Early Tracheotomy

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The incidence and risk factors of ventilator-associated pneumonia in patients with severe traumatic brain injury

Medicinski pregled ◽

10.2298/mpns1108403m ◽

2011 ◽

Vol 64 (7-8) ◽

pp. 403-407 ◽

Cited By ~ 2

Author(s):

Vesna Marjanovic ◽

Vesna Novak ◽

Ljubinka Velickovic ◽

Goran Marjanovic

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Traumatic Brain Injury ◽

Mechanical Ventilation ◽

Intensive Care ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Prolonged Mechanical Ventilation ◽

Chest Injury ◽

Ventilator Associated Pneumonia

Introduction. Patients with severe traumatic brain injury are at a risk of developing ventilator-associated pneumonia. The aim of this study was to describe the incidence, etiology, risk factors for development of ventilator- associated pneumonia and outcome in patients with severe traumatic brain injury. Material and Methods. A retrospective study was done in 72 patients with severe traumatic brain injury, who required mechanical ventilation for more than 48 hours. Results. Ventilator-associated pneumonia was found in 31 of 72 (43.06%) patients with severe traumatic brain injury. The risk factors for ventilator-associated pneumonia were: prolonged mechanical ventilation (12.42 vs 4.34 days, p<0.001), longer stay at intensive care unit (17 vs 5 days, p<0.001) and chest injury (51.61 vs 19.51%, p< 0.009) compared to patients without ventilator-associated pneumonia.. The mortality rate in the patients with ventilator-associated pneumonia was higher (38.71 vs 21.95%, p= 0.12). Conclusion. The development of ventilator-associated pneumonia in patients with severe traumatic brain injury led to the increased morbidity due to the prolonged mechanical ventilation, longer stay at intensive care unit and chest injury, but had no effect on mortality.

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THE INFLUENCE OF DIFFERENT VENTILATION PATTERNS ON TREATMENT OF PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY

International Journal of Medicine and Medical Research ◽

10.11603/ijmmr.2413-6077.2016.2.7031 ◽

2017 ◽

Author(s):

O. V. Oliynyk ◽

B. O. Pereviznyk ◽

A. Shlifirchyk

Keyword(s):

Traumatic Brain Injury ◽

Mechanical Ventilation ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Lung Ventilation ◽

Respiratory Support ◽

Volume Control ◽

Forced Ventilation

Background. Respiratory support is a vital method for temporary compensation of external breathing function in patients with severe traumatic brain injury. However, it is not always possible to deal with severe respiratory dysfunction even with the usage of up-to-date respiratory technologies. This work is aimed to find an answer how different pattern of mechanical ventilation influence on a treatment of patients with severe traumatic brain injury. Objective. The influence of respiratory support, as a main method for temporary compensation of external breathing function, on treatment result for patients with severe traumatic brain injury.Methods. Treatment results of 253 patients with severe traumatic brain injury of Ternopil University Hospital were evaluated due to the type of respiratory support used. The results were separately evaluated in alive and dead patients.Results. Mortality rate of patients depended on the type of mechanical ventilation that was used. The highest mortality (58.69 %) was in the group, when a patient was transferred to forced ventilation a volume control. The mortality rate was decreasing by 51.78% in case of adding PEEP. The strategy of using accessory lung ventilation patterns CPAP and BiPAP caused significant (in 1.48 times) decrease of mortality in this group of patients.Conclusion The survival of patients with severe traumatic brain injury, who were ventilated by the method of consistent combination of forced ventilation with pressure control (CРV) and 2 patterns of accessory lung ventilation: Constant Positive Airway Pressure (CPAP) and Biphasic positive airway pressure (BiPAP), is reliably higher than in the case of forced ventilation with volume control with Positive end-expiratory pressure.

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