VENTILatOry strategies in patients with severe traumatic brain injury: the VENTILO Survey of the European Society of Intensive Care Medicine (ESICM)
Por:
Picetti, E, Pelosi, P, Taccone, FS, Citerio, G, Mancebo, J, Robba, C, ESICM NIC ARF Sect
Publicada:
17 abr 2020
Resumen:
Background 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. Methods An electronic questionnaire, including 38 items and 3 different clinical scenarios [arterial partial pressure of oxygen (PaO2)/inspired fraction of oxygen (FiO(2)) > 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. Results 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/FiO(2) 150-300) and 4-6 ml/kg/PBW in scenario 3 (53% PaO2/FiO(2) < 150). The most common level of highest positive end-expiratory pressure (PEEP) used was 15 cmH(2)O in patients with a PaO2/FiO(2) <= 300 without intracranial hypertension (41% if PaO2/FiO(2) 150-300 and 50% if PaO2/FiO(2) < 150) and 10 cmH(2)O in patients with intracranial hypertension (32% if PaO2/FiO(2) 150-300 and 33% if PaO2/FiO(2) < 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%)]. Conclusions 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.
Filiaciones:
Picetti, E:
Parma Univ Hosp, Dept Anesthesia & Intens Care, Via Gramsci 14, I-43100 Parma, Italy
Pelosi, P:
IRCCS Oncol & Neurosci, Dept Anesthesia & Intens Care, Genoa, Italy
Univ Genoa, Dept Surg Sci & Integrated Diagnost, Genoa, Italy
Taccone, FS:
Univ Libre Bruxelles, Dept Intens Care, Erasme Hosp, Brussels, Belgium
Citerio, G:
Univ Milano Bicocca, Sch Med & Surg, Monza, Italy
Mancebo, J:
St Pau Hosp, Dept Intens Care, Barcelona, Spain
Robba, C:
IRCCS Oncol & Neurosci, Dept Anesthesia & Intens Care, Genoa, Italy
Gold, Green Published
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