Tidal Volume Lowering by Instrumental Dead Space Reduction in Brain-Injured ARDS Patients: Effects on Respiratory Mechanics, Gas Exchange, and Cerebral Hemodynamics

Background Limiting tidal volume ( V T ), plateau pressure, and driving pressure is essential during the acute respiratory distress syndrome (ARDS), but may be challenging when brain injury coexists due to the risk of hypercapnia. Because lowering dead space enhances CO 2 clearance, we conducted a s...

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Bibliographic Details
Published in:Neurocritical care 2021-02, Vol.34 (1), p.21-30
Main Authors: Pitoni, Sara, D’Arrigo, Sonia, Grieco, Domenico Luca, Idone, Francesco Antonio, Santantonio, Maria Teresa, Di Giannatale, Pierluigi, Ferrieri, Alessandro, Natalini, Daniele, Eleuteri, Davide, Jonson, Bjorn, Antonelli, Massimo, Maggiore, Salvatore Maurizio
Format: Article
Language:English
Subjects:
Carbon dioxide
Critical Care Medicine
Flow velocity
Hemodynamics
Hemorrhage
Intensive
Internal Medicine
Intracranial pressure
Mechanics
Medicine
Medicine & Public Health
Neurology
Neurosurgery
Original Work
Physiology
Respiratory system
Traumatic brain injury
Ventilators
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Summary:Background Limiting tidal volume ( V T ), plateau pressure, and driving pressure is essential during the acute respiratory distress syndrome (ARDS), but may be challenging when brain injury coexists due to the risk of hypercapnia. Because lowering dead space enhances CO 2 clearance, we conducted a study to determine whether and to what extent replacing heat and moisture exchangers (HME) with heated humidifiers (HH) facilitate safe V T lowering in brain-injured patients with ARDS. Methods Brain-injured patients (head trauma or spontaneous cerebral hemorrhage with Glasgow Coma Scale at admission 
ISSN:1541-6933
1556-0961
DOI:10.1007/s12028-020-00969-5