Journal article

Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus.

  • Robba C San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
  • Poole D Anesthesia and Intensive Care Operative Unit, S. Martino Hospital, Belluno, Italy.
  • McNett M Implementation Science, The Helene Fuld Health Trust National Institute for EBP, College of Nursing, The Ohio State University, Columbus, OH, USA.
  • Asehnoune K Department of Anaesthesia and Critical Care, Hôtel Dieu, University Hospital of Nantes, Nantes, France.
  • Bösel J Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
  • Bruder N Anesthesiology-Intensive Care Department, Aix-Marseille University, APHM, CHU Timone, Marseille, France.
  • Chieregato A Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Cinotti R Department of Anaesthesia and Critical Care, Hôpital Guillaume et René Laennec, University Hospital of Nantes, Saint-Herblain, France.
  • Duranteau J Department of Anesthesiology and Perioperative Intensive Care Medicine, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Paris-Saclay University, Paris, France.
  • Einav S Faculty of Medicine, Intensive Care Unit of the Shaare Zedek Medical Centre and Hebrew University, Jerusalem, Israel.
  • Ercole A University of Cambridge Division of Anaesthesia, Addenbrooke's Hospital, Cambridge, UK.
  • Ferguson N Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
  • Guerin C Medecine Intensive-Réanimation, Hopital Edouard Herriot, University of Lyon, Lyon, France.
  • Siempos II First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
  • Kurtz P Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil.
  • Juffermans NP Department of Intensive Care Medicine, Olvg Hospital, Amsterdam, The Netherlands.
  • Mancebo J Servei Medicina Intensiva, Hospital Sant Pau, Barcelona, Spain.
  • Mascia L Alma Mater Studiorum, Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.
  • McCredie V Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
  • Nin N Department of Intensive Care Medicine, Hospital Español, Montevideo, Uruguay.
  • Oddo M Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland.
  • Pelosi P San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
  • Rabinstein AA Department of Neurology, Mayo Clinic, Rochester, MN, USA.
  • Neto AS Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
  • Seder DB Department of Critical Care Services, Neuroscience Institute, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA.
  • Skrifvars MB Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Meilahden sairaala, Haartmaninkatu 4, 00029 HUS, Helsinki, Finland.
  • Suarez JI Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Phipps 455, Baltimore, MD, 21287, USA.
  • Taccone FS Department of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
  • van der Jagt M Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands.
  • Citerio G School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy.
  • Stevens RD Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Phipps 455, Baltimore, MD, 21287, USA. rstevens@jhmi.edu.
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  • 2020-11-11
Published in:
  • Intensive care medicine. - 2020
English 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.
Language
  • English
Open access status
bronze
Identifiers
Persistent URL
https://sonar.ch/global/documents/115855
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