[Role of assisted breathing in severe traumatic brain injury]

Abstract

Background: Based on available data, there is no definite clinical research describing option, timing and effects of assisted as opposed to controlled ventilation to successfully treat acute severely brain-injured patients. This study demonstrates pressure support ventilation as a possible alternative to controlled ventilation in the acute phase of brain injury. We illustrated which factors influenced the shift from total (CPPV) to partial ventilatory support (PS-SIGH) and the consequences of assisted ventilation on cerebral hemodynamics.

Methods: a)

Experimental design: Retrospective, cohort study. b)

Setting: Adult intensive care unit of a university hospital. c) Patients population: Forty-two severe head-trauma victims (GCS </= 8). d) Measures and interventions: Ventilation modalities and parameters, systemic and cerebral hemodynamics [Intracranial pressure (ICP), cerebral perfusion pressure (CPP), jugular bulb oxygen saturation (SjvO(2))] data were collected daily and described.

Results: Controlled ventilation was the main ventilatory support during the very first moment of brain trauma. Percentage of patients ventilated with pressure support increased progressively (37.5% on day 2) and was the dominant method of ventilation on the fourth day. Worst neurologic condition and more elevated ICP were associated to controlled ventilation. Carbon dioxide partial pressure was higher in PS-SIGH, however, it was not correlated with significantly elevated ICP.

Conclusions: In traumatic brain injured patients, ICP and CPP monitoring, together with neurological examination are the main factors influencing the selection of ventilatory assistance. It is evident from these data that assisted ventilation is a feasible and safe alternative to controlled ventilation even in the acute phase of trauma if intracranial parameters are continuously monitored and controlled.