Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus
Por:
Robba, C, Poole, D, McNett, M, Asehnoune, K, Bosel, J, Bruder, N, Chieregato, A, Cinotti, R, Duranteau, J, Einav, S, Ercole, A, Ferguson, N, Guerin, C, Siempos, II, Kurtz, P, Juffermans, NP, Mancebo, J, Mascia, L, McCredie, V, Nin, N, Oddo, M, Pelosi, P, Rabinstein, AA, Neto, AS, Seder, DB, Skrifvars, MB, Suarez, JI, Taccone, FS, van der Jagt, M, Citerio, G, Stevens, RD
Publicada:
1 dic 2020
Ahead of Print:
1 nov 2020
Resumen:
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.
Filiaciones:
Robba, C:
San Martino Policlin Hosp, IRCCS Oncol & Neurosci, Genoa, Italy
Poole, D:
San Martino Hosp, Anesthesia & Intens Care Operat Unit, Belluno, Italy
McNett, M:
Ohio State Univ, Coll Nursing, Helene Fuld Hlth Trust Natl Inst EBP, Implementat Sci, Columbus, OH 43210 USA
Asehnoune, K:
Univ Hosp Nantes, Dept Anaesthesia & Crit Care, Hotel Dieu, Nantes, France
Bosel, J:
Univ Hosp Heidelberg, Dept Neurol, Heidelberg, Germany
Klinikum Kassel, Dept Neurol, Kassel, Germany
Bruder, N:
Aix Marseille Univ, CHU Timone, AP HM, Anesthesiol Intens Care Dept, Marseille, France
Chieregato, A:
ASST Grande Osped Metropolitano Niguarda, Neurointens Care Unit, Milan, Italy
Cinotti, R:
Univ Hosp Nantes, Dept Anaesthesia & Crit Care, Hop Guillaume & Rene Laennec, St Herblain, France
Duranteau, J:
Paris Saclay Univ, Bicetre Hosp, AP HP, Dept Anesthesiol & Perioperat Intens Care Med, Paris, France
Einav, S:
Shaare Zedek Med Ctr, Fac Med, Intens Care Unit, Jerusalem, Israel
Hebrew Univ Jerusalem, Jerusalem, Israel
Ercole, A:
Univ Cambridge, Addenbrookes Hosp, Div Anaesthesia, Cambridge, England
Ferguson, N:
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Univ Toronto, Dept Physiol, Toronto, ON, Canada
Guerin, C:
Univ Lyon, Med Intens Reanimat, Hop Edouard Herriot, Lyon, France
INSERM, Creteil, France
Siempos, II:
Natl & Kapodistrian Univ Athens, Evangelismos Hosp, Dept Crit Care Med & Pulm Serv 1, Med Sch, Athens, Greece
New York Presbyterian Hosp, Weill Cornell Med, Weill Cornell Med Ctr, Div Pulm & Crit Care Med,Dept Med, New York, NY USA
Kurtz, P:
Inst Estadual Cerebro Paulo Niemeyer, Dept Neurointens Care, Rio De Janeiro, Brazil
Juffermans, NP:
Olvg Hosp, Dept Intens Care Med, Amsterdam, Netherlands
Univ Amsterdam, Lab Expt Intens Care & Anesthesiol, Med Ctr, Amsterdam, Netherlands
Mancebo, J:
Hosp Sant Pau, Serv Med Intens, Barcelona, Spain
Mascia, L:
Univ Bologna, Alma Mater Studiorum, Dipartimento Sci Biomed & Neuromotorie, Bologna, Italy
McCredie, V:
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Nin, N:
Hosp Espanol, Dept Intens Care Med, Montevideo, Uruguay
Oddo, M:
Univ Lausanne, Dept Intens Care Med, Ctr Hosp Univ Vaudois CHUV, Lausanne, Switzerland
Pelosi, P:
San Martino Policlin Hosp, IRCCS Oncol & Neurosci, Genoa, Italy
Univ Genoa, Dept Surg Sci & Integrated Diagnost, Genoa, Italy
Rabinstein, AA:
Mayo Clin, Dept Neurol, Rochester, MN USA
Neto, AS:
Monash Univ, Australian & New Zealand Intens Care Res Ctr ANZI, Sch Publ Hlth & Prevent Med, Melbourne, Vic, Australia
Hosp Israelita Alberto Einstein, Dept Crit Care Med, Sao Paulo, Brazil
Seder, DB:
Maine Med Ctr, Neurosci Inst, Dept Crit Care Serv, 22 Bramhall St, Portland, ME 04102 USA
Skrifvars, MB:
Univ Helsinki, Dept Emergency Care & Serv, HUS Helsinki, Haartmaninkatu 4, Helsinki 00029, Finland
Helsinki Univ Hosp, HUS Helsinki, Haartmaninkatu 4, Helsinki 00029, Finland
Suarez, JI:
Johns Hopkins Univ, Sch Med, Dept Anesthesiol & Crit Care Med, 600 N Wolfe St,Phipps 455, Baltimore, MD 21287 USA
Johns Hopkins Univ, Sch Med, Dept Neurol, Baltimore, MD 21205 USA
Johns Hopkins Univ, Sch Med, Dept Neurosurg, Baltimore, MD 21205 USA
Taccone, FS:
Univ Libre Bruxelles, Erasme Hosp, Dept Intens Care Med, Brussels, Belgium
van der Jagt, M:
Erasmus MC, Dept Intens Care, Rotterdam, Netherlands
Citerio, G:
Univ Milano Bicocca, Sch Med & Surg, Milan, Italy
Stevens, RD:
Johns Hopkins Univ, Sch Med, Dept Anesthesiol & Crit Care Med, 600 N Wolfe St,Phipps 455, Baltimore, MD 21287 USA
Johns Hopkins Univ, Sch Med, Dept Neurol, Baltimore, MD 21205 USA
Johns Hopkins Univ, Sch Med, Dept Neurosurg, Baltimore, MD 21205 USA
Green Submitted, Green Accepted, Green Published, Bronze
|