Respiratory Management for Traumatic Brain Injury

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Introduction

In cases of Traumatic Brain Injury [TBI] respiratory dysfunction is the most common medical complication which occurs[1][2].

Up to one third of patients with severe TBI develop Acute Respiratory Distress Syndrome [ARDS][3][4].

Respiratory Assessment of TBI Patient

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Respiratory Management

In the acute stages of TBI, the aims of management in the Intensive Care Unit are to maintain oxygen delivery in order to limit secondary neurological damage. Mechanical ventilation is commonly used with 3 aims: 1. To prevent/minimise hypoxia 2. To prevent/minimise hypercapnia 3. To protect the airway from risk of aspiration. It is acknowledged that difficulties are frequently encountered when weaning these patients from mechanical ventilation[5]. A number of recent studies have investigated the use of protective ventilation in the early stages following TBI[6][7].

References

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  1. Solenski NJ, Haley EC, Kassell NF, Kongable G, Germanson T, Truskowski L, Torner JC. Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study. Crit Care Med. 1995;23:1007–1017.
  2. Plötz FB, Slutsky AS, van Vught AJ, Heijnen CJ. Ventilator-induced lung injury and multiple system organ failure: a critical review of facts and hypotheses. Intensive Care Med. 2004;30:1865–1872.
  3. Holland MC, Mackersie RC, Morabito D, Campbell AR, Kivett VA, Patel R, Erickson VR, Pittet JF. The development of acute lung injury is associated with worse neurologic outcome in patients with severe traumatic brain injury. J Trauma. 2003;55:106–111. 
  4. Kahn JM, Caldwell EC, Deem S, Newell DW, Heckbert SR, Rubenfeld GD. Acute lung injury in patients with subarachnoid hemorrhage: incidence, risk factors, and outcome. Crit Care Med. 2006;34:196–202.
  5. Coplin WM, Pierson DJ, Cooley KD, et al. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med. 2000;161:1530–6.
  6. Asehnoune K, Seguin P, Lasocki S, et al. Extubation success prediction in a multicentric cohort of patients with severe brain injury. Anesthesiology. 2017;127:338–46.
  7. Godet T, Chabanne R, Marin J, et al. Extubation failure in brain-injured patients: risk factors and development of a prediction score in a preliminary prospective cohort study. Anesthesiology. 2017;126:104–14.