VENTILatOry strategies in patients with severe traumatic brain injury : The VENTILO Survey of the European Society of Intensive Care Medicine (ESICM)
Picetti, E. (University Hospital of Parma)
Pelosi, P. (University of Genoa)
Taccone, F.S. (Université Libre de Bruxelles (ULB))
Citerio, G. (University of Milan - Bicocca)
Mancebo, Jordi (Institut d'Investigació Biomèdica Sant Pau)
Robba, C. (IRCCS for Oncology and Neurosciences)
Universitat Autònoma de Barcelona

Date:	2020
Abstract:	Severe traumatic brain injury (TBI) patients often develop acute respiratory failure. Optimal ventilator strategies in this setting are not well established. We performed an international survey to investigate the practice in the ventilatory management of TBI patients with and without respiratory failure. An electronic questionnaire, including 38 items and 3 different clinical scenarios [arterial partial pressure of oxygen (PaO)/inspired fraction of oxygen (FiO) > 300 (scenario 1), 150-300 (scenario 2), < 150 (scenario 3)], was available on the European Society of Intensive Care Medicine (ESICM) website between November 2018 and March 2019. The survey was endorsed by ESICM. There were 687 respondents [472 (69%) from Europe], mainly intensivists [328 (48%)] and anesthesiologists [206 (30%)]. A standard protocol for mechanical ventilation in TBI patients was utilized by 277 (40%) respondents and a specific weaning protocol by 198 (30%). The most common tidal volume (TV) applied was 6-8 ml/kg of predicted body weight (PBW) in scenarios 1-2 (72% PaO/FIO > 300 and 61% PaO/FiO 150-300) and 4-6 ml/kg/PBW in scenario 3 (53% PaO/FiO < 150). The most common level of highest positive end-expiratory pressure (PEEP) used was 15 cmHO in patients with a PaO/FiO ≤ 300 without intracranial hypertension (41% if PaO/FiO 150-300 and 50% if PaO/FiO < 150) and 10 cmHO in patients with intracranial hypertension (32% if PaO/FiO 150-300 and 33% if PaO/FiO < 150). Regardless of the presence of intracranial hypertension, the most common carbon dioxide target remained 36-40 mmHg whereas the most common PaO target was 81-100 mmHg in all the 3 scenarios. The most frequent rescue strategies utilized in case of refractory respiratory failure despite conventional ventilator settings were neuromuscular blocking agents [406 (88%)], recruitment manoeuvres [319 (69%)] and prone position [292 (63%)]. Ventilatory management, targets and practice of adult severe TBI patients with and without respiratory failure are widely different among centres. These findings may be helpful to define future investigations in this topic.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Mechanical ventilation ; Respiratory failure ; Traumatic brain injury
Published in:	Critical Care, Vol. 24 Núm. 1 (17 2020) , p. 158, ISSN 1466-609X

DOI: 10.1186/s13054-020-02875-w
PMID: 32303255

9 p, 914.9 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
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