Department of Anesthesiology and Critical Care Medicine, Konkuk University School of Medicine, Seoul, Korea
ABSTRACT
Endotracheal intubation and mechanical ventilation are essential to the resuscitation of neurocriitical care patients, fulfilling multiple goals, including ensuring protection of the airway, participating in tissue oxygen delivery, and indirectly modulating cerebral vascular reactivity. Neurologically injured patients with mechanical ventilation also are at increased risks most notably ventilator-associated pneumonia, ventilator-induced lung injury, delirium, and the frequent need for sedation, which decreases the sensitivity of neurologic assessment and can occult critical clinical information. Positive pressure ventilation may adversely affect cerebral perfusion pressure, although the importance of this effect may be overestimated in most clinical settings. Patients who have severe brain injury are at increased risk for acute lung injury/acute respiratory distress syndrome and may develop ventilator-induced lung injury. When there is concurrent intracranial hypertension and acute lung injury/acute respiratory distress syndrome, therapies aimed at optimizing brain physiology may conflict with mechanical ventilation strategies aimed at lung protection. The purpose of this review is to discuss functional abnormalities, clinical treatment, and possible prevention of respiratory function abnormalities in neurologically injured patients.
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