Background
Historical Practices in Mechanical Ventilation
Tidal Volume
Current practice | Evolution of practice | |
---|---|---|
Tidal volume | > 8 ml/kg IBW | 6–7 ml/kg IBW |
PEEP | 0–3 cmH2O | ≥ 5 cmH2O |
Extubation management | Awaiting recovery or awareness | Negative fluid balance Cough Gag reflex VISAGE score: – Age < 40 – GGS > 10 – Visual pursuit – Swallowing |
Tracheostomy management | ? | ? |
Low Positive End-expiratory Pressure
Weaning from Invasive Mechanical Ventilation and Extubation
New Perspectives: How to Set Mechanical Ventilation in Clinical Practice
When Should we Perform Extubation After Brain Injury?
First author [ref] | Number of patients with brain injury | Baseline GCS | GCS at extubation | Extubation failure rate (%) | In-ICU mortality rate (%) |
---|---|---|---|---|---|
Navalesi [26] (intervention/control groups) | 165/153 | 9.4 ± 1.9/9.3 ± 1.9 | 10.6 ± 0.7/10.5 ± 0.9 | 5/12 | 1/4 |
Qureshi [32] | 69 | Unknown | Unknown | 67 | 39 |
Reis [35] (success/failure groups) | 311 | 9.7 ± 4.4 | Unknown | 13.8 | 3/14 |
Coplin [6] | 136 | Unknown | Unknown | 17.4 | 16.1 |
Namen [21] (intervention/control groups) | 100 | Unknown | 8.3 ± 2.6 | 38 | 41/31 |
Karanjia [36] | 1265 | Unknown | 11 ± 3 | 6.1 | Unknown |
Wendell [37] (success/failure groups) | 37 | 11 (8–14)/11.5 (7–14) | 13 (9–14)/10.5 (8–14) | 21 | 8/20 |
Godet [11] (success/failure groups) | 140 | 8 (5–11)/6 (4–9) | 9 (8–10)/9 (7–10) | 31 | 1/19 |
McCredie [12] (success/failure groups) | 192 | 7 (4–9)/7(6–9) | 9(8–10)/9(8–10) | 21 | 1/13 |
Asehnoune [10] (success/failure groups) | 437 | 7(5–10)/7(3–10) | 11 (10–14)/11 (9–13) | 22.6 | 1.2/11.1 |
When Should we Perform Tracheostomy After Brain Injury?
First author [ref] | Number of patients | Tracheostomy, n (%) | General in-ICU mortality, n (%) | In-ICU mortality in patients with tracheostomy, n (%) |
---|---|---|---|---|
Navalesi [26] | 318 | 16 (5) | 8 (2) | Unknown |
Qureshi [32] | 69 | 23 (33) | 27 (39) | Unknown |
Reis [35] | 311 | 29 (9) | 21 (6) | Unknown |
Coplin [6] | 136 | 4 (3) | 22 (16.1) | Unknown |
Namen [21] | 100 | 29 (29) | 36 (36) | Unknown |
Karanjia [36] | 1265 | 181 (14) | Unknown | Unknown |
Wendell [37] | 37 | 3 (8) | 5 (13.5) | Unknown |
Godet [11] | 140 | 9 (6.4) | 9 (6.4) | Unknown |
Asehnoune [10] | 437 | 40 (9.1) | 15 (3.4) | 2 (0.4) |