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


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2020-11-11

AUTHORS

Chiara Robba, Daniele Poole, Molly McNett, Karim Asehnoune, Julian Bösel, Nicolas Bruder, Arturo Chieregato, Raphael Cinotti, Jacques Duranteau, Sharon Einav, Ari Ercole, Niall Ferguson, Claude Guerin, Ilias I. Siempos, Pedro Kurtz, Nicole P. Juffermans, Jordi Mancebo, Luciana Mascia, Victoria McCredie, Nicolas Nin, Mauro Oddo, Paolo Pelosi, Alejandro A. Rabinstein, Ary Serpa Neto, David B. Seder, Markus B. Skrifvars, Jose I. Suarez, Fabio Silvio Taccone, Mathieu van der Jagt, Giuseppe Citerio, Robert D. Stevens

ABSTRACT

PurposeTo provide clinical practice recommendations and generate a research agenda on mechanical ventilation and respiratory support in patients with acute brain injury (ABI).MethodsAn 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.ResultsThe 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.ConclusionsThis 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. More... »

PAGES

2397-2410

Journal

TITLE

Intensive Care Medicine

ISSUE

12

VOLUME

46

Author Affiliations

  • San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
  • Anesthesia and Intensive Care Operative Unit, S. Martino Hospital, Belluno, Italy
  • Implementation Science, The Helene Fuld Health Trust National Institute for EBP, College of Nursing, The Ohio State University, Columbus, OH, USA
  • Department of Anaesthesia and Critical Care, Hôtel Dieu, University Hospital of Nantes, Nantes, France
  • Department of Neurology, Klinikum Kassel, Kassel, Germany
  • Anesthesiology-Intensive Care Department, Aix-Marseille University, APHM, CHU Timone, Marseille, France
  • Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
  • Department of Anaesthesia and Critical Care, Hôpital Guillaume et René Laennec, University Hospital of Nantes, Saint-Herblain, France
  • Department of Anesthesiology and Perioperative Intensive Care Medicine, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Paris-Saclay University, Paris, France
  • Faculty of Medicine, Intensive Care Unit of the Shaare Zedek Medical Centre and Hebrew University, Jerusalem, Israel
  • University of Cambridge Division of Anaesthesia, Addenbrooke’s Hospital, Cambridge, UK
  • Department of Physiology, University of Toronto, Toronto, ON, Canada
  • INSERM 955, Créteil, France
  • Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, NY, USA
  • Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
  • Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
  • Servei Medicina Intensiva, Hospital Sant Pau, Barcelona, Spain
  • Alma Mater Studiorum, Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
  • Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
  • Department of Intensive Care Medicine, Hospital Español, Montevideo, Uruguay
  • Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
  • Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
  • Department of Neurology, Mayo Clinic, Rochester, MN, USA
  • Department of Critical Care Medicine, Hospital Israelita Alberto Einstein, São Paulo, Brazil
  • Department of Critical Care Services, Neuroscience Institute, Maine Medical Center, 22 Bramhall Street, 04102, Portland, ME, USA
  • Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Meilahden sairaala, Haartmaninkatu 4, 00029 HUS, Helsinki, Finland
  • Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  • Department of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
  • Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
  • School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00134-020-06283-0

    DOI

    http://dx.doi.org/10.1007/s00134-020-06283-0

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1132508041

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/33175276


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