Respiratory care

Abstract 

Purpose of the review

Neurosurgical patients frequently develop respiratory complications, adversely affecting neurologic outcome and survival. The review summarizes current literature and management of respiratory complications associated with brain injury.

Major findings

Respiratory complications are commonly associated with traumatic brain injury and subarachnoid haemorrhage. Lung-protective ventilation with reduced tidal volumes improves outcome in acute lung injury, and should be applied to neurosurgical patients in the absence of increased intracranial pressure. Weaning from the mechanical ventilation should be initiated as soon as possible, although the role of neurological status in the weaning process is not clear. Prevention of pneumonia and aspiration improves survival. In patients with difficult weaning, early bedside percutaneous tracheostomy should be considered.

Further Investigations

Further studies are warranted to elucidate an optimal oxygenation and ventilation in brain-injured patients, weaning strategies, predictors of the failed weaning and extubation, respiratory support in patients with difficulties to wean, and early tracheostomy.

Key words: brain injury, subarachnoid haemorrhage, hyperventilation, lung-protective strategy of ventilation, PEEP, weaning, extubation, tracheostomy