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

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

EMERGENCY MEDICINE ◽

10.22141/2224-0586.17.6.2021.242324 ◽

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.

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Emergency department predictors of tracheostomy in patients with isolated traumatic brain injury requiring emergency cranial decompression

Journal of Neurosurgery ◽

10.3171/2011.7.jns101829 ◽

2011 ◽

Vol 115 (5) ◽

pp. 1007-1012 ◽

Cited By ~ 11

Author(s):

Muhammad Shahzad Shamim ◽

Mohsin Qadeer ◽

Ghulam Murtaza ◽

S. Ather Enam ◽

Najiha B. Farooqi

Keyword(s):

Traumatic Brain Injury ◽

Emergency Department ◽

Mechanical Ventilation ◽

Brain Injury ◽

Chart Review ◽

Prolonged Mechanical Ventilation ◽

Multivariate Logistic Regression Analysis ◽

Retrospective Chart Review ◽

Severe Tbi ◽

Small Cohort

Object Patients with severe traumatic brain injury (TBI) frequently require a tracheostomy for prolonged mechanical ventilation and/or pulmonary toilet. It is now proven that the earlier the procedure is done, the more beneficial it is to the patient. The present study was carried out to determine if the requirement of a tracheostomy can be predicted on arrival of a patient to the emergency department. The prediction can potentially aid in combining the procedure with cranial decompression. In this study, the authors' aim was to determine the emergency department predictors of tracheostomy in patients with isolated TBI requiring emergency cranial decompression. Methods The authors performed a retrospective chart review of all patients who underwent surgery for isolated TBI and required more than 4 days of mechanical ventilation. Multivariate logistic regression analysis was used for predictive indicators. Results In patients with isolated severe TBI, a patient age of 31–50 years, the presence of preexisting medical comorbid conditions, a delay in emergency department arrival exceeding 1.5 hours, an abnormal pupil response on arrival, and a preoperative neurological worsening during hospital stay were independent predictors of the requirement for tracheostomy. These findings were validated in a small cohort of patients and were found to be significant. Conclusions Requirement of a tracheostomy can be predicted in patients with severe TBI on arrival to the emergency department. These results were validated in a small cohort of patients, and it was found that the positive predictive value of requirement of tracheostomy was directly proportional to the number of predictors present. Larger prospective studies with appropriate control groups are further recommended to validate the authors' findings.

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Assessment of the effect of continuous sedation with mechanical ventilation on adrenal insufficiency in patients with traumatic brain injury

Journal of Investigative Medicine ◽

10.1136/jim-2015-000012 ◽

2016 ◽

Vol 64 (3) ◽

pp. 752-758 ◽

Cited By ~ 2

Author(s):

Min Li ◽

Ying Zhang ◽

Kang-Song Wu ◽

Ying-Hong Hu

Keyword(s):

Traumatic Brain Injury ◽

Mechanical Ventilation ◽

Regression Analysis ◽

Brain Injury ◽

Adrenal Insufficiency ◽

Prolonged Mechanical Ventilation ◽

Multivariate Regression Analysis ◽

Factors Affecting ◽

Continuous Sedation ◽

Sedation Group

The aim of this study was to assess the effect of continuous propofol sedation plus prolonged mechanical ventilation on adrenal insufficiency (AI) in patients with traumatic brain injury (TBI). Eighty-five adult patients diagnosed with moderate TBI (Glasgow Coma Scale (GCS) score 9–13) from October 2011 to October 2012 were included in this prospective study. The patients comprised three groups: no mechanical ventilation and sedation (n=27), mechanical ventilation alone (n=24) and mechanical ventilation plus sedation (n=34). The low-dose short Synacthen test was performed at 8:00 on the first, third, and fifth days after TBI. Logistic regression analysis was performed to identify factors affecting the use of mechanical ventilation and sedation, and the incidence of AI. On the fifth day after injury, the mean baseline cortisol and simulated cortisol levels were significantly lower in the mechanical ventilation plus sedation group compared with the other two groups. Multivariate regression analysis showed that the Acute Physiology and Chronic Health Evaluation (APACHE) score was independently associated with treatment with mechanical ventilation and sedation compared to mechanical ventilation alone. Furthermore, hypoxemia on admission and shock were associated with the development of AI. The findings showed that sedation is associated with an increased incidence of AI. Patients with TBI who are treated with continuous sedation should be monitored for AI carefully.

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

Air Medical Journal ◽

10.1016/j.amj.2020.04.020 ◽

2020 ◽

Vol 39 (5) ◽

pp. 410-413 ◽

Cited By ~ 1

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

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Using trauma registry data to predict prolonged mechanical ventilation in patients with traumatic brain injury: Machine learning approach

PLoS ONE ◽

10.1371/journal.pone.0235231 ◽

2020 ◽

Vol 15 (7) ◽

pp. e0235231 ◽

Cited By ~ 1

Author(s):

Ahmad Abujaber ◽

Adam Fadlalla ◽

Diala Gammoh ◽

Husham Abdelrahman ◽

Monira Mollazehi ◽

...

Keyword(s):

Machine Learning ◽

Traumatic Brain Injury ◽

Mechanical Ventilation ◽

Brain Injury ◽

Trauma Registry ◽

Prolonged Mechanical Ventilation ◽

Registry Data ◽

Learning Approach ◽

Machine Learning Approach

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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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