scholarly journals Mechanical ventilation in patients with severe traumatic brain injury: modern guidelines review

2021 ◽  
Vol 17 (6) ◽  
pp. 28-34
Author(s):  
D.A. Krishtafor ◽  
O.M. Klygunenko ◽  
O.V. Kravets ◽  
V.V. Yekhalov ◽  
O.V. Liashchenko
Keyword(s):  
Traumatic Brain Injury ◽  
Mechanical Ventilation ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Distress Syndrome ◽  
Extubation Failure ◽  
Neurological Patients ◽  
Ventilation Modes ◽  
Common Group ◽  
Ventilation Strategies

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.

Epidemiology and Outcomes of Acute Respiratory Distress Syndrome Following Isolated Severe Traumatic Brain Injury

2020 ◽  
pp. 088506662097200
Author(s):  
Jordan M. Komisarow ◽  
Fangyu Chen ◽  
Monica S. Vavilala ◽  
Daniel Laskowitz ◽  
Michael L. James ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Brain Injury ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Severe Tbi

Patients with traumatic brain injury (TBI) are at risk for extra-cranial complications, such as the acute respiratory distress syndrome (ARDS). We conducted an analysis of risk factors, mortality, and healthcare utilization associated with ARDS following isolated severe TBI. The National Trauma Data Bank (NTDB) dataset files from 2007-2014 were used to identify adult patients who suffered isolated [other body region-specific Abbreviated Injury Scale (AIS) < 3] severe TBI [admission total Glasgow Coma Scale (GCS) from 3 to 8 and head region-specific AIS >3]. In-hospital mortality was compared between patients who developed ARDS and those who did not. Utilization of healthcare resources (ICU length of stay, hospital length of stay, duration of mechanical ventilation, and frequency of tracheostomy and gastrostomy tube placement) was also examined. This retrospective cohort study included 38,213 patients with an overall ARDS occurrence of 7.5%. Younger age, admission tachycardia, pre-existing vascular and respiratory diseases, and pneumonia were associated with the development of ARDS. Compared to patients without ARDS, patients that developed ARDS experienced increased in-hospital mortality (OR 1.13, 95% CI 1.01-1.26), length of stay (p = <0.001), duration of mechanical ventilation (p = < 0.001), and placement of tracheostomy (OR 2.70, 95% CI 2.34-3.13) and gastrostomy (OR 2.42, 95% CI 2.06-2.84). After isolated severe TBI, ARDS is associated with increased mortality and healthcare utilization. Future studies should focus on both prevention and management strategies specific to TBI-associated ARDS.

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

2020 ◽  
Vol 39 (5) ◽  
pp. 410-413 ◽  
Author(s):  
Bentley Woods Curry ◽  
Steven Ward ◽  
Christopher J. Lindsell ◽  
Kimberly W. Hart ◽  
Jason T. McMullan
Keyword(s):  
Traumatic Brain Injury ◽  
Mechanical Ventilation ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Prehospital Setting

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

2011 ◽  
Vol 64 (7-8) ◽  
pp. 403-407 ◽  
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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