Bridging brain and lung: optimizing mechanical ventilation in acute brain injury

Area of Science:

• Critical Care Medicine
• Neurocritical Care
• Respiratory Physiology

Background:

• Mechanical ventilation in acute brain injury (ABI) is challenging, balancing brain protection and preventing ventilator-induced lung injury (VILI).
• Maintaining normoxia and normocapnia is crucial to prevent cerebral ischemia and intracranial hypertension.
• Limited evidence exists for optimal tidal volume and PEEP settings in ABI patients.

Purpose of the Study:

• To review current physiological principles in ventilating ABI patients.
• To discuss challenges in protecting both brain and lungs during mechanical ventilation.
• To explore precision ventilation strategies informed by multimodal monitoring.

Main Methods:

• Narrative review synthesizing current physiological principles and evidence.
• Discussion of advanced neuromonitoring techniques (e.g., PbtO₂, TCD).
• Exploration of emerging automated and adaptive ventilation modes.

Main Results:

• Mechanical ventilation in ABI necessitates individualized strategies due to complex respiratory and cerebral interplay.
• Neuromonitoring provides critical real-time data to guide ventilation.
• Automated ventilation modes may improve patient-ventilator synchrony and gas exchange.

Conclusions:

• Precision ventilation strategies, guided by multimodal monitoring, are evolving for ABI management.
• Integrating advanced monitoring and adaptive ventilation may improve neurological and respiratory outcomes.
• Further research is needed to close evidence gaps in optimizing ventilation for ABI.