Focused Management of Patients With Severe Acute Brain Injury and ARDS

Autor: Jamie Nicole LaBuzetta, Christa O'Hana S. Nobleza, Deepa Malaiyandi, Clio Rubinos, Emily J. Gilmore, Nicholas J. Johnson, Aarti Sarwal, Jennifer A. Kim, Shraddha Mainali, Sarah Wahlster, Kristine H. O’Phalen
Rok vydání: 2022
Předmět:
Pulmonary and Respiratory Medicine
medicine.medical_specialty
ARDS
Coronavirus disease 2019 (COVID-19)
Traumatic brain injury
medicine.medical_treatment
HT
hyperosmolar therapy
PEEP
positive end-expiratory pressure
LTVMV
low tidal volume mechanical ventilation
sABI
severe acute brain injury
Disease
Critical Care and Intensive Care Medicine
CSF
cerebrospinal fluid
TBI
traumatic brain injury
CPP
cerebral perfusion pressure
IH
intracranial hypertension
Intensive care
Extracorporeal membrane oxygenation
medicine
acute brain injury
Humans
Intensive care medicine
intensive care
Respiratory Distress Syndrome
SARS-CoV-2
business.industry
COVID-19
Disease Management
medicine.disease
NMB
neuromuscular blockade
Patient population
HD
hospital day
ICP
intracranial pressure
Critical Care: CHEST Reviews
intracranial hypertension
PP
prone positioning
Brain Injuries
EVD
external ventricular drain
Narrative review
SAH
subarachnoid hemorrhage
Cardiology and Cardiovascular Medicine
business
ECMO
extracorporeal membrane oxygenation
Zdroj: Chest
ISSN: 0012-3692
DOI: 10.1016/j.chest.2021.08.066
Popis: Considering the COVID-19 pandemic where concomitant occurrence of ARDS and severe acute brain injury (sABI) has increasingly coemerged, we synthesize existing data regarding the simultaneous management of both conditions. Our aim is to provide readers with fundamental principles and concepts for the management of sABI and ARDS, and highlight challenges and conflicts encountered while managing concurrent disease. Up to 40% of patients with sABI can develop ARDS. Although there are trials and guidelines to support the mainstays of treatment for ARDS and sABI independently, guidance on concomitant management is limited. Treatment strategies aimed at managing severe ARDS may at times conflict with the management of sABI. In this narrative review, we discuss the physiological basis and risks involved during simultaneous management of ARDS and sABI, summarize evidence for treatment decisions, and demonstrate these principles using hypothetical case scenarios. Use of invasive or noninvasive monitoring to assess brain and lung physiology may facilitate goal-directed treatment strategies with the potential to improve outcome. Understanding the pathophysiology and key treatment concepts for comanagement of these conditions is critical to optimizing care in this high-acuity patient population.
Databáze: OpenAIRE
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