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Airway Management in Patients With Acute Brain Injury or Ischemia
1Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts.
The Journal of Emergency Medicine
|May 10, 2025
Summary
Proper airway management during endotracheal intubation is crucial for patients with acute brain injury or ischemia. Key strategies include hemodynamic stability, preoxygenation, and avoiding hypotension to prevent secondary brain injury and improve outcomes.
Area of Science:
- Emergency Medicine
- Neurocritical Care
- Airway Management
Background:
- Endotracheal intubation in emergency medicine requires careful consideration for patients with acute brain injury or ischemia.
- Improper airway management can lead to secondary brain injury, exacerbating neurological deficits.
Purpose of the Study:
- To provide evidence-based recommendations for airway management in patients with acute brain injury or ischemia.
- To guide clinicians on optimal practices before, during, and after endotracheal intubation.
Main Methods:
- Review of current evidence on airway management techniques and pharmacological agents.
- Analysis of physiological effects of interventions on cerebral perfusion pressure and intracranial pressure.
Main Results:
- Pre-intubation management should focus on blood pressure control, preoxygenation, and managing elevated intracranial pressure.
- Hemodynamically neutral induction agents like ketamine or etomidate are recommended to prevent hypotension.
- Video laryngoscopy and post-intubation management targeting eucapnia are advised.
Conclusions:
- Adherence to these principles minimizes the risk of secondary brain injury in patients with acute brain injury or ischemia.
- Optimized airway management strategies contribute to better patient outcomes.
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