Brain Protective Ventilation Strategies in Severe Acute Brain Injury
Issued Date
2025-10-13
Resource Type
eISSN
15346293
Scopus ID
2-s2.0-105018527709
Pubmed ID
41082009
Journal Title
Current Neurology and Neuroscience Reports
Volume
25
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Current Neurology and Neuroscience Reports Vol.25 No.1 (2025) , 68
Suggested Citation
Sharie S.A., Almari R., Azzam S., Al-Husinat L., Araydah M., Battaglini D., Schultz M.J., Patroniti N.A., Rocco P.R.M., Robba C. Brain Protective Ventilation Strategies in Severe Acute Brain Injury. Current Neurology and Neuroscience Reports Vol.25 No.1 (2025) , 68. doi:10.1007/s11910-025-01462-2 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/112672
Title
Brain Protective Ventilation Strategies in Severe Acute Brain Injury
Author's Affiliation
Universidade Federal do Rio de Janeiro
Università degli Studi di Genova
Amsterdam UMC - University of Amsterdam
Medizinische Universität Wien
Vanderbilt University Medical Center
IRCCS San Martino Polyclinic Hospital
Nuffield Department of Medicine
Yarmouk University
Mahidol Oxford Tropical Medicine Research Unit
Istishari Hospital, Amman
Università degli Studi di Genova
Amsterdam UMC - University of Amsterdam
Medizinische Universität Wien
Vanderbilt University Medical Center
IRCCS San Martino Polyclinic Hospital
Nuffield Department of Medicine
Yarmouk University
Mahidol Oxford Tropical Medicine Research Unit
Istishari Hospital, Amman
Corresponding Author(s)
Other Contributor(s)
Abstract
PURPOSE OF THE REVIEW: This narrative review synthesizes ten key evidence-based principles for optimizing ventilatory management in patients with acute brain injury, including traumatic brain injury, stroke, and hypoxic-ischemic encephalopathy. RECENT FINDINGS: We emphasize the need to individualize ventilator settings to preserve intracranial pressure (ICP) and cerebral perfusion pressure (CPP), while maintaining lung-protective strategies. Key recommendations include prioritizing physiological targets over ventilator modes, judicious use of positive end-expiratory pressure (PEEP) with concurrent cerebral monitoring, limiting plateau pressures, and maintaining tidal volumes within protective ranges. Minimizing driving pressure (ΔP) and mechanical power (MP) is emphasized to reduce the risk of ventilator-induced lung injury (VILI). The review underscores the importance of precise control of arterial carbon dioxide (PaCO₂) to regulate cerebral blood flow, avoidance of both hypoxemia and hyperoxia, and the integration of multimodal neuromonitoring to inform ventilatory decisions. Additional considerations include the potential benefits of early tracheostomy in patients requiring prolonged ventilation, as well as the influence of sedation depth, fluid management, and autoregulation monitoring on outcomes. By aligning respiratory support with cerebral pathophysiology, clinicians can mitigate secondary brain injury and enhance recovery in this vulnerable population.