Ventilatory setting in severe brain injured patients: does it really matter?

Excerpt

The presence of pulmonary dysfunction in severe brain injury is a well known phenomenon. Development of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) occurs in 20–25% of patients with isolated brain injury, both subarachnoid hemorrhage and trauma, and is associated with a threefold increased risk of dying and increased ICU length of stay [1, 2, 3]. Intensive Care Medicine now present an elegant physiological study carried out by Koutsoukou and coworkers [4] to assess respiratory mechanics in the early phase after severe brain injury. The authors conclude that on the first day of mechanical ventilation patients with brain damage exhibit abnormal respiratory mechanics. Static elastance and minimal resistance further increased after 5 days in patients ventilated on zero end-expiratory pressure (ZEEP) while it remained stable in patients ventilated with a moderate level of positive end expiratory pressure (PEEP). In the present editorial we discuss: (a) the mechanisms of pulmonary dysfunction, (b) its clinical relevance, and (c) the potential “conflict of interest” between the protective ventilation strategy for ALI/ARDS and the ventilatory settings proposed for brain injured patients. …