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Updated: Aug 10, 2025
06:18
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
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Ventilatory targets following brain injury.
Shaurya Taran1,2, Sarah Wahlster3,4,5, Chiara Robba6,7
1Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
Current Opinion in Critical Care
|February 10, 2023
Summary
Optimal mechanical ventilation for acute brain injury (ABI) requires careful titration to balance brain and lung needs. While injurious ventilation worsens outcomes, precise targets for ABI patients are still being defined.
Area of Science:
- Critical Care Medicine
- Neurocritical Care
- Pulmonology
Background:
- Mechanical ventilation strategies for acute brain injury (ABI) are under intense investigation.
- Understanding the impact of ventilation parameters on intracranial pressure and cerebral perfusion is crucial.
- Existing evidence highlights the detrimental effects of injurious ventilation on ABI patient outcomes.
Approach:
- This review synthesizes current research on mechanical ventilation in ABI.
- It provides practical, bedside guidance for titrating ventilatory settings.
- Emphasis is placed on managing brain-lung interactions.
Key Points:
- Low tidal volume ventilation and PEEP affect intracranial pressure and cerebral perfusion.
- Ventilatory parameters like driving pressure and mechanical power correlate with outcomes in ABI.
- Optimizing ventilation requires balancing oxygenation, CO2 levels, and intracranial pressure.
Conclusions:
- Direct evidence for mechanical ventilation in ABI is growing but remains limited.
- Ventilatory strategies should be extrapolated from general critical care data, considering ABI-specific effects.
- Individualized management is key to resolving brain-lung conflicts in ABI patients.
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