Mechanical ventilation in aneurysmal subarachnoid hemorrhage: systematic review and recommendations

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...

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Bibliographic Details
Published in:Critical care (London, England) England), 2020-09, Vol.24 (1), p.1-575, Article 575
Main Authors: Towner, James E, Rahmani, Redi, Zammit, Christopher G, Khan, Imad R, Paul, David A, Bhalla, Tarun, Roberts, Debra E
Format: Article
Language:English
Subjects:
Aneurysm
APRV
Blood
Carbon dioxide
Critical care
Edema
Hemorrhage
Intracranial pressure
Ischemia
Mechanical ventilation
Medical research
Mortality
Pathophysiology
Patients
Pediatrics
Physiological aspects
Pneumonia
Pressure control
Respiratory distress syndrome
Review
Sepsis
Stroke
Subarachnoid hemorrhage
Systematic review
Ventilators
Volume control
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Summary: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: Mechanical ventilation, Aneurysm, Subarachnoid hemorrhage, APRV, Pressure control, Volume control
ISSN:1364-8535
1364-8535
1366-609X
1466-609X
DOI:10.1186/s13054-020-03269-8