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Neurologic Injury and Mechanical Ventilation

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Textbook of Neurointensive Care

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Abstract

Patients with many different types of neurologic injury may develop respiratory system failure for a variety of reasons. In addition, the potential complications of respiratory system failure, including hypoxemia and acidosis, may cause significant additional injury to patients with neurologic disease. Mechanical ventilation (MV) is a supportive therapy that can be used to prevent these systemic complications of respiratory system failure in patients with and without neurologic injury.

While MV is generally delivered through one of several conventional modes of ventilation, several advanced modes of ventilation have also been recently developed to further increase the effectiveness of MV. Regardless of the mode of MV used, careful titration and monitoring of many different MV settings is needed to optimize oxygenation and ventilation. The use of one or more adjunctive therapies may be necessary to improve oxygenation in conditions associated with severe respiratory system dysfunction, such as acute respiratory distress syndrome (ARDS). Specific protocols have been described for MV in these patients to gain the maximum benefit to the patient while reducing the potential for complications.

Ventilator separation (typically through tracheal extubation) is an important consideration in MV therapy. The use of protocolized spontaneous breathing trials to determine the optimum timing for ventilator separation has not been validated in patients with neurologic disease; nevertheless, a daily evaluation for the appropriateness of extubation is probably warranted. Careful monitoring for recovery of neurologic dysfunction is an important facet to ventilator separation as many patients may have resolution of their respiratory system dysfunction but cannot be separated from MV due to their underlying neurologic injury.

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Authors and Affiliations

  1. Division of Critical Care Medicine, Department of Anesthesiology, University of Kentucky, 800 Rose Street, Lexington, KY, 40502, USA

    Kevin W. Hatton MD

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  1. Kevin W. Hatton MD
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Correspondence to Kevin W. Hatton MD .

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Editors and Affiliations

  1. Pulmonary and Critical Care Medicine, Geisinger Health System, Danville, Pennsylvania, USA

    A Joseph Layon

  2. Departments of Anesthesiology & Surgery, University of Florida College of Medicine, Gainesville, Florida, USA

    Andrea Gabrielli

  3. Department of Neurosurgery, University of Florida, Gainesville, Florida, USA

    William A. Friedman

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Hatton, K.W. (2013). Neurologic Injury and Mechanical Ventilation. In: Layon, A., Gabrielli, A., Friedman, W. (eds) Textbook of Neurointensive Care. Springer, London. https://doi.org/10.1007/978-1-4471-5226-2_11

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