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

Chiara Robba¹, Daniele Poole², Molly McNett³, Karim Asehnoune⁴, Julian Bösel^{5

6}, Nicolas Bruder⁷, Arturo Chieregato⁸, Raphael Cinotti⁹, Jacques Duranteau¹⁰, Sharon Einav¹¹, Ari Ercole¹², Niall Ferguson^{13

14}, Claude Guerin^{15

16}, Ilias I Siempos^{17

18}, Pedro Kurtz¹⁹, Nicole P Juffermans^{20

21}, Jordi Mancebo²², Luciana Mascia²³, Victoria McCredie¹³, Nicolas Nin²⁴, Mauro Oddo²⁵, Paolo Pelosi^{1

26}, Alejandro A Rabinstein²⁷, Ary Serpa Neto^{28

29}, David B Seder³⁰, Markus B Skrifvars³¹, Jose I Suarez^{32

33

34}, Fabio Silvio Taccone³⁵, Mathieu van der Jagt³⁶, Giuseppe Citerio³⁷, Robert D Stevens^{38

39

40}

Affiliations

¹ San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
² Anesthesia and Intensive Care Operative Unit, S. Martino Hospital, Belluno, Italy.
³ Implementation Science, The Helene Fuld Health Trust National Institute for EBP, College of Nursing, The Ohio State University, Columbus, OH, USA.
⁴ Department of Anaesthesia and Critical Care, Hôtel Dieu, University Hospital of Nantes, Nantes, France.
⁵ Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
⁶ Department of Neurology, Klinikum Kassel, Kassel, Germany.
⁷ Anesthesiology-Intensive Care Department, Aix-Marseille University, APHM, CHU Timone, Marseille, France.
⁸ Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
⁹ Department of Anaesthesia and Critical Care, Hôpital Guillaume et René Laennec, University Hospital of Nantes, Saint-Herblain, France.
¹⁰ Department of Anesthesiology and Perioperative Intensive Care Medicine, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Paris-Saclay University, Paris, France.
¹¹ Faculty of Medicine, Intensive Care Unit of the Shaare Zedek Medical Centre and Hebrew University, Jerusalem, Israel.
¹² University of Cambridge Division of Anaesthesia, Addenbrooke's Hospital, Cambridge, UK.
¹³ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
¹⁴ Department of Physiology, University of Toronto, Toronto, ON, Canada.
¹⁵ Medecine Intensive-Réanimation, Hopital Edouard Herriot, University of Lyon, Lyon, France.
¹⁶ INSERM 955, Créteil, France.
¹⁷ First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
¹⁸ 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.
¹⁹ Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil.
²⁰ Department of Intensive Care Medicine, Olvg Hospital, Amsterdam, The Netherlands.
²¹ Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
²² Servei Medicina Intensiva, Hospital Sant Pau, Barcelona, Spain.
²³ Alma Mater Studiorum, Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.
²⁴ Department of Intensive Care Medicine, Hospital Español, Montevideo, Uruguay.
²⁵ Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland.
²⁶ Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
²⁷ Department of Neurology, Mayo Clinic, Rochester, MN, USA.
²⁸ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
²⁹ Department of Critical Care Medicine, Hospital Israelita Alberto Einstein, São Paulo, Brazil.
³⁰ Department of Critical Care Services, Neuroscience Institute, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA.
³¹ Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Meilahden sairaala, Haartmaninkatu 4, 00029 HUS, Helsinki, Finland.
³² Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Phipps 455, Baltimore, MD, 21287, USA.
³³ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³⁴ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³⁵ Department of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
³⁶ Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands.
³⁷ School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy.
³⁸ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Phipps 455, Baltimore, MD, 21287, USA. rstevens@jhmi.edu.
³⁹ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. rstevens@jhmi.edu.
⁴⁰ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. rstevens@jhmi.edu.

PMID: 33175276
PMCID: PMC7655906
DOI: 10.1007/s00134-020-06283-0

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

Chiara Robba et al. Intensive Care Med. 2020 Dec.

. 2020 Dec;46(12):2397-2410.

doi: 10.1007/s00134-020-06283-0. Epub 2020 Nov 11.

Authors

Affiliations

¹ San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
² Anesthesia and Intensive Care Operative Unit, S. Martino Hospital, Belluno, Italy.
³ Implementation Science, The Helene Fuld Health Trust National Institute for EBP, College of Nursing, The Ohio State University, Columbus, OH, USA.
⁴ Department of Anaesthesia and Critical Care, Hôtel Dieu, University Hospital of Nantes, Nantes, France.
⁵ Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
⁶ Department of Neurology, Klinikum Kassel, Kassel, Germany.
⁷ Anesthesiology-Intensive Care Department, Aix-Marseille University, APHM, CHU Timone, Marseille, France.
⁸ Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
⁹ Department of Anaesthesia and Critical Care, Hôpital Guillaume et René Laennec, University Hospital of Nantes, Saint-Herblain, France.
¹⁰ Department of Anesthesiology and Perioperative Intensive Care Medicine, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Paris-Saclay University, Paris, France.
¹¹ Faculty of Medicine, Intensive Care Unit of the Shaare Zedek Medical Centre and Hebrew University, Jerusalem, Israel.
¹² University of Cambridge Division of Anaesthesia, Addenbrooke's Hospital, Cambridge, UK.
¹³ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
¹⁴ Department of Physiology, University of Toronto, Toronto, ON, Canada.
¹⁵ Medecine Intensive-Réanimation, Hopital Edouard Herriot, University of Lyon, Lyon, France.
¹⁶ INSERM 955, Créteil, France.
¹⁷ First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
¹⁸ 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.
¹⁹ Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil.
²⁰ Department of Intensive Care Medicine, Olvg Hospital, Amsterdam, The Netherlands.
²¹ Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
²² Servei Medicina Intensiva, Hospital Sant Pau, Barcelona, Spain.
²³ Alma Mater Studiorum, Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.
²⁴ Department of Intensive Care Medicine, Hospital Español, Montevideo, Uruguay.
²⁵ Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland.
²⁶ Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
²⁷ Department of Neurology, Mayo Clinic, Rochester, MN, USA.
²⁸ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
²⁹ Department of Critical Care Medicine, Hospital Israelita Alberto Einstein, São Paulo, Brazil.
³⁰ Department of Critical Care Services, Neuroscience Institute, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA.
³¹ Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Meilahden sairaala, Haartmaninkatu 4, 00029 HUS, Helsinki, Finland.
³² Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Phipps 455, Baltimore, MD, 21287, USA.
³³ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³⁴ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³⁵ Department of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
³⁶ Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands.
³⁷ School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy.
³⁸ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Phipps 455, Baltimore, MD, 21287, USA. rstevens@jhmi.edu.
³⁹ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. rstevens@jhmi.edu.
⁴⁰ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. rstevens@jhmi.edu.

PMID: 33175276
PMCID: PMC7655906
DOI: 10.1007/s00134-020-06283-0

Abstract

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.

Keywords: ARDS; Acute stroke; Mechanical ventilation; Respiratory failure; Subarachnoid hemorrhage; Traumatic brain injury.

PubMed Disclaimer

Conflict of interest statement

GC is Editor in Chief of ICM. MS received speaker fee and travel grant from BARD Medical (Ireland) and a research grant from GE Healthcare. JB received Speaker honoraria and travel support from Boehringer Ingelheim, Medtronic, Zoll, Sedana Medical. DS is PI of the SETPOINT2 trial on early tracheostomy in ventilated cerebrovascular ICU patients and participant in a PCORI Award for SETPOINT2. SE has support from Zoll, Siemens and Medtronic, research funding from Oridion, Diasorin, Haemonetics, participation in multicenter trials for Artisanpharma, Ely Lily, Takeda, Astra Zeneca, Eisai. The other authors have no COI to declare.

Comment in

Acute respiratory distress syndrome complicating traumatic brain injury. Can opposite strategies converge?
Robba C, Camporota L, Citerio G. Robba C, et al. Intensive Care Med. 2023 May;49(5):583-586. doi: 10.1007/s00134-023-07043-6. Epub 2023 Apr 5. Intensive Care Med. 2023. PMID: 37017697 No abstract available.

References

1. Del Sorbo L, Goligher EC, McAuley DF, et al. Mechanical ventilation in adults with acute respiratory distress syndrome: summary of the experimental evidence for the clinical practice guideline. Ann Am Thorac Soc. 2017;14:S261–S270. doi: 10.1513/AnnalsATS.201704-345OT. - DOI - PubMed
1. Kienbaum P, Pelosi P, Gama de Abreu M, et al. Temporal changes in ventilator settings in patients with uninjured lungs. Anesth Analg. 2008;2018:1. - PubMed
1. Stevens RD, Lazaridis C, Chalela JA. The role of mechanical ventilation in acute brain injury. Neurol Clin. 2008;26:543–563. doi: 10.1016/j.ncl.2008.03.014. - DOI - PubMed
1. Cinotti R, Bouras M, Roquilly A, Asehnoune K. Management and weaning from mechanical ventilation in neurologic patients. Ann Transl Med. 2019;6:381. doi: 10.21037/atm.2018.08.16. - DOI - PMC - PubMed
1. Della Torre V, Badenes R, Corradi F, Racca F, Lavinio A, Matta B, Bilotta F, Robba C. Acute respiratory distress syndrome in traumatic brain injury: how do we manage it? J Thorac Dis. 2017;9(12):5368–5381. doi: 10.21037/jtd.2017.11.03. - DOI - PMC - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- ClinicalTrials.gov

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical