Open AccessMechanical ventilation in patients with severe traumatic brain injury: modern guidelines review
Author(s) -
Д.А. Криштафор,
O.М. Кlygunenko,
O.V. Kravets,
V.V. Yekhalov,
O.V. Liashchenko
Publication year - 2021
Publication title -
medicina neotložnyh sostoânij
Language(s) - English
Resource type - Journals
eISSN - 2307-1230
pISSN - 2224-0586
DOI - 10.22141/2224-0586.17.6.2021.242324
Subject(s) - medicine , glasgow coma scale , mechanical ventilation , anesthesia , traumatic brain injury , intubation , ventilation (architecture) , tracheal intubation , engineering , mechanical engineering , psychiatry
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.