Mechanical ventilation in aneurysmal subarachnoid hemorrhage: systematic review and recommendations

Critical Care

James E. Towner¹  David A. Paul¹  Redi Rahmani¹  Tarun Bhalla²  Imad R. Khan³  Debra E. Roberts⁴  Christopher G. Zammit⁵ 

[1] Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Ave, 14642, Rochester, NY, USA;Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Ave, 14642, Rochester, NY, USA;Department of Imaging Sciences, University of Rochester Medical Center, Box 670, 601 Elmwood Ave, 14642, Rochester, NY, USA;Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, 14642, Rochester, NY, USA;Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Ave, 14642, Rochester, NY, USA;Division of Neurocritical Care, Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, 14642, Rochester, NY, USA;Division of Pulmonary Diseases and Critical Care, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Ave, 14642, Rochester, NY, USA;Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Ave, 14642, Rochester, NY, USA;Division of Neurocritical Care, Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, 14642, Rochester, NY, USA;Division of Pulmonary Diseases and Critical Care, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Ave, 14642, Rochester, NY, USA;Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, 601 Elmwood Ave, 14642, Rochester, NY, USA;Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Ave, 14642, Rochester, NY, USA;Division of Neurocritical Care, Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, 14642, Rochester, NY, USA;Division of Pulmonary Diseases and Critical Care, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Ave, 14642, Rochester, NY, USA;TriHealth Critical Care, 10506 Montgomery Road, Suite 301, 45242, Cincinnatir, OH, USA;

关键词: Mechanical ventilation;    Aneurysm;    Subarachnoid hemorrhage;    APRV;    Pressure control;    Volume control;   

DOI  :  10.1186/s13054-020-03269-8

来源: Springer

【 摘 要 】

ObjectiveMechanical 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 sourcesPubMed 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 selectionStudy 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 extractionArticles were reviewed by one team member, and interpretation was verified by a second team member.Data synthesisThirty-one articles met the inclusion criteria for this review.ConclusionsWe make recommendations on oxygenation, hypercapnia, PEEP, APRV, ARDS, and intracranial pressure monitoring.

【 授权许可】

CC BY