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. 2020 Sep 24;24(1):575.
doi: 10.1186/s13054-020-03269-8.

Mechanical ventilation in aneurysmal subarachnoid hemorrhage: systematic review and recommendations

James E Towner  1 , Redi Rahmani  2 , Christopher G Zammit  1   3   4   5 , Imad R Khan  1   3   4 , David A Paul  1 , Tarun Bhalla  1   6   7 , Debra E Roberts  1   3   4   8
Affiliations

Mechanical ventilation in aneurysmal subarachnoid hemorrhage: systematic review and recommendations

James E Towner et al. Crit Care. .

Abstract

Objective: Mechanical ventilation (MV) has a complex interplay with the pathophysiology of aneurysmal subarachnoid hemorrhage (aSAH). We aim to provide a review of the physiology of MV in patients with aSAH, give recommendations based on a systematic review of the literature, and highlight areas that still need investigation.

Data sources: PubMed was queried for publications with the Medical Subject Headings (MeSH) terms "mechanical ventilation" and "aneurysmal subarachnoid hemorrhage" published between January 1, 1990, and March 1, 2020. Bibliographies of returned articles were reviewed for additional publications of interest.

Study selection: Study inclusion criteria included English language manuscripts with the study population being aSAH patients and the exposure being MV. Eligible studies included randomized controlled trials, observational trials, retrospective trials, case-control studies, case reports, or physiologic studies. Topics and articles excluded included review articles, pediatric populations, non-aneurysmal etiologies of subarachnoid hemorrhage, mycotic and traumatic subarachnoid hemorrhage, and articles regarding tracheostomies.

Data extraction: Articles were reviewed by one team member, and interpretation was verified by a second team member.

Data synthesis: Thirty-one articles met the inclusion criteria for this review.

Conclusions: We make recommendations on oxygenation, hypercapnia, PEEP, APRV, ARDS, and intracranial pressure monitoring.

Keywords: APRV; Aneurysm; Mechanical ventilation; Pressure control; Subarachnoid hemorrhage; Volume control.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Head CT showing the unique challenges of an aneurysmal subarachnoid hemorrhage patient. a There is a significant amount of basilar cistern subarachnoid hemorrhage placing the patient at high risk for delayed cerebral ischemia. b There is prominent hydrocephalus needing CSF diversion to lower intracranial pressure
Fig. 2
Fig. 2
PRISMA flow sheet for systematic review
See this image and copyright information in PMC

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