Mechanical ventilation in patients with severe traumatic brain injury: modern guidelines review

Traumatic brain injury is the most common group of injuries among victims admitted to emergency departments. Up 20 % individuals with damage require endotracheal intubation and mechanical ventilation, duration which significantly longer than in non-neurological patients. Such patients have a higher incidence acute respiratory distress syndrome ventilator-associated pneumonia, weaning extubation are associated significant difficulties. However, traumatic often excluded from randomized trials, international guidelines for treatment severe do not provide clear ventilation strategies. Analysis literature allowed us identify modern principles support injury, include: tracheal Glasgow coma scale score ≤ 8 points; early ventilation; PaO2 range 80–120 mm Hg (SaO2 ≥ 95 %), PaCO2 — 35–45 Hg; tidal volume ml/kg; rate ≈ 20/min; PEEP 5 cm H2O; head elevation by 30°; sedation poor synchronization respirator; respirator through use modes; when reaching 3 points on VISAGE scale; (up 4 days) tracheostomy predicted failure.