VENTILatOry strategies in patients with severe traumatic brain injury: the VENTILO Survey of the European Society of Intensive Care Medicine (ESICM)
Open Access
- 17 April 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Critical Care
- Vol. 24 (1), 1-9
- https://doi.org/10.1186/s13054-020-02875-w
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 (PaO2)/inspired fraction of oxygen (FiO2) > 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% PaO2/FIO2 > 300 and 61% PaO2/FiO2 150–300) and 4–6 ml/kg/PBW in scenario 3 (53% PaO2/FiO2 < 150). The most common level of highest positive end-expiratory pressure (PEEP) used was 15 cmH2O in patients with a PaO2/FiO2 ≤ 300 without intracranial hypertension (41% if PaO2/FiO2 150–300 and 50% if PaO2/FiO2 < 150) and 10 cmH2O in patients with intracranial hypertension (32% if PaO2/FiO2 150–300 and 33% if PaO2/FiO2 < 150). Regardless of the presence of intracranial hypertension, the most common carbon dioxide target remained 36–40 mmHg whereas the most common PaO2 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.Keywords
This publication has 45 references indexed in Scilit:
- What respiratory targets should be recommended in patients with brain injury and respiratory failure?Intensive Care Medicine, 2019
- Respiratory Management in Patients with Severe Brain InjuryCritical Care, 2018
- Acute Respiratory Distress SyndromeJAMA, 2018
- Traumatic brain injury: integrated approaches to improve prevention, clinical care, and researchThe Lancet Neurology, 2017
- ARDS in the brain-injured patient: what’s different?Intensive Care Medicine, 2016
- Protective versus Conventional Ventilation for SurgeryAnesthesiology, 2015
- Ventilator-Induced Lung InjuryThe New England Journal of Medicine, 2013
- Impact of Acute Lung Injury and Acute Respiratory Distress Syndrome After Traumatic Brain Injury in the United StatesNeurosurgery, 2012
- Management and outcome of mechanically ventilated neurologic patients*Critical Care Medicine, 2011
- Extracranial complications of severe head injuryJournal of Neurosurgery, 1992