TY - JOUR
T1 - Mechanical ventilation in patients with acute brain injury
T2 - recommendations of the European Society of Intensive Care Medicine consensus
AU - Robba, Chiara
AU - Poole, Daniele
AU - McNett, Molly
AU - Asehnoune, Karim
AU - Bösel, Julian
AU - Bruder, Nicolas
AU - Chieregato, Arturo
AU - Cinotti, Raphael
AU - Duranteau, Jacques
AU - Einav, Sharon
AU - Ercole, Ari
AU - Ferguson, Niall
AU - Guerin, Claude
AU - Siempos, Ilias I.
AU - Kurtz, Pedro
AU - Juffermans, Nicole P.
AU - Mancebo, Jordi
AU - Mascia, Luciana
AU - McCredie, Victoria
AU - Nin, Nicolas
AU - Oddo, Mauro
AU - Pelosi, Paolo
AU - Rabinstein, Alejandro A.
AU - Neto, Ary Serpa
AU - Seder, David B.
AU - Skrifvars, Markus B.
AU - Suarez, Jose I.
AU - Taccone, Fabio Silvio
AU - van der Jagt, Mathieu
AU - Citerio, Giuseppe
AU - Stevens, Robert D.
N1 - Publisher Copyright:
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2020/12
Y1 - 2020/12
N2 - 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.
AB - 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.
KW - ARDS
KW - Acute stroke
KW - Mechanical ventilation
KW - Respiratory failure
KW - Subarachnoid hemorrhage
KW - Traumatic brain injury
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U2 - 10.1007/s00134-020-06283-0
DO - 10.1007/s00134-020-06283-0
M3 - Article
C2 - 33175276
AN - SCOPUS:85096022954
SN - 0342-4642
VL - 46
SP - 2397
EP - 2410
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 12
ER -