Mechanical ventilation in patients with acute brain injury : recommendations of the European Society of Intensive Care Medicine consensus

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Robba , C , Poole , D , McNett , M , Asehnoune , K , Boesel , J , Bruder , N , Chieregato , A , Cinotti , R , Duranteau , J , Einav , S , Ercole , A , Ferguson , N , Guerin , C , Siempos , I I , Kurtz , P , Juffermans , N P , Mancebo , J , Mascia , L , McCredie , V , Nin , N , Oddo , M , Pelosi , P , Rabinstein , A A , Neto , A S , Seder , D B , Skrifvars , M B , Suarez , J I , Taccone , F S , van der Jagt , M , Citerio , G & Stevens , R D 2020 , ' Mechanical ventilation in patients with acute brain injury : recommendations of the European Society of Intensive Care Medicine consensus ' , Intensive Care Medicine , vol. 46 , no. 12 , pp. 2397-2410 . https://doi.org/10.1007/s00134-020-06283-0

Title: Mechanical ventilation in patients with acute brain injury : recommendations of the European Society of Intensive Care Medicine consensus
Author: Robba, Chiara; Poole, Daniele; McNett, Molly; Asehnoune, Karim; Boesel, Julian; Bruder, Nicolas; Chieregato, Arturo; Cinotti, Raphael; Duranteau, Jacques; Einav, Sharon; Ercole, Ari; Ferguson, Niall; Guerin, Claude; Siempos, Ilias I.; Kurtz, Pedro; Juffermans, Nicole P.; Mancebo, Jordi; Mascia, Luciana; McCredie, Victoria; Nin, Nicolas; Oddo, Mauro; Pelosi, Paolo; Rabinstein, Alejandro A.; Neto, Ary Serpa; Seder, David B.; Skrifvars, Markus B.; Suarez, Jose I.; Taccone, Fabio Silvio; van der Jagt, Mathieu; Citerio, Giuseppe; Stevens, Robert D.
Contributor organization: HUS Emergency Medicine and Services
Department of Diagnostics and Therapeutics
University of Helsinki
Helsinki University Hospital Area
Date: 2020-12
Language: eng
Number of pages: 14
Belongs to series: Intensive Care Medicine
ISSN: 0342-4642
DOI: https://doi.org/10.1007/s00134-020-06283-0
URI: http://hdl.handle.net/10138/336202
Abstract: Purpose To provide clinical practice recommendations and generate a research agenda on mechanical ventilation and respiratory support in patients with acute brain injury (ABI). Methods An international consensus panel was convened including 29 clinician-scientists in intensive care medicine with expertise in acute respiratory failure, neurointensive care, or both, and two non-voting methodologists. The panel was divided into seven subgroups, each addressing a predefined clinical practice domain relevant to patients admitted to the intensive care unit (ICU) with ABI, defined as acute traumatic brain or cerebrovascular injury. The panel conducted systematic searches and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to evaluate evidence and formulate questions. A modified Delphi process was implemented with four rounds of voting in which panellists were asked to respond to questions (rounds 1-3) and then recommendation statements (final round). Strong recommendation, weak recommendation, or no recommendation were defined when > 85%, 75-85%, and <75% of panellists, respectively, agreed with a statement. Results The GRADE rating was low, very low, or absent across domains. The consensus produced 36 statements (19 strong recommendations, 6 weak recommendations, 11 no recommendation) regarding airway management, non-invasive respiratory support, strategies for mechanical ventilation, rescue interventions for respiratory failure, ventilator liberation, and tracheostomy in brain-injured patients. Several knowledge gaps were identified to inform future research efforts. Conclusions This consensus provides guidance for the care of patients admitted to the ICU with ABI. Evidence was generally insufficient or lacking, and research is needed to demonstrate the feasibility, safety, and efficacy of different management approaches.
Subject: Mechanical ventilation
Respiratory failure
ARDS
Traumatic brain injury
Acute stroke
Subarachnoid hemorrhage
RESPIRATORY-DISTRESS-SYNDROME
ACUTE LUNG INJURY
TIDAL VOLUMES
PREDICTION
OUTCOMES
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Usage restriction: openAccess
Self-archived version: acceptedVersion


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