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Respiratory Care of Neurologic Patient

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Textbook of Neuroanesthesia and Neurocritical Care

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Abstract

Neurologic patients often require prolonged mechanical ventilation due to inability to protect the airway. Ventilatory strategies should aim to preserve oxygenation, to maintain carbon dioxide levels within acceptable ranges, and moreover to reach an adequate blood flow and cerebral perfusion pressure in order to prevent secondary brain damage. However, there is no unanimous agreement on ventilatory strategy in brain-injured patients because brain and lungs have complex interactions and small ventilatory changes may lead to important changes in cerebral physiology. Furthermore, the best ventilatory strategy is not entirely clear and still debated. In addition, neurocritical patients present high incidence of secondary lung injury and that makes the choice of ventilatory setting difficult. When avoidance of intubation is warranted, non-invasive support techniques could be considered. Weaning should be initiated as soon as possible because of the complications associated with prolonged intubation and tracheostomy. Scores and protocols used in general critically ill patients might not be directly applicable to neurocritical patients. Tracheostomy could promote earlier weaning because in neurological patients the predominant cause of respiratory dysfunction is not ventilation itself, but rather the inability to maintain upper airways patency. The better timing to tracheostomy in neurological ICU patient is still unknown, but usually a cutoff of 2 weeks of mechanical ventilation is applicable also in these patients. The aim of this chapter is to provide a comprehensive overview of the pathophysiologic and clinical aspects concerning the respiratory care of the neurologic patient.

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Authors and Affiliations

  1. Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Policlinico San Martino, IRCCS per l’Oncologia, Università degli Studi di Genova, Genoa, Italy

    Lorenzo Ball, Denise Battaglini & Paolo Pelosi

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  1. Lorenzo Ball
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  2. Denise Battaglini
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  3. Paolo Pelosi
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Editors and Affiliations

  1. Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India

    Hemanshu Prabhakar

  2. Division of Neuroanesthesiology, Department of Anesthesiology, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India

    Zulfiqar Ali

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Ball, L., Battaglini, D., Pelosi, P. (2019). Respiratory Care of Neurologic Patient. In: Prabhakar, H., Ali, Z. (eds) Textbook of Neuroanesthesia and Neurocritical Care. Springer, Singapore. https://doi.org/10.1007/978-981-13-3390-3_14

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  • DOI: https://doi.org/10.1007/978-981-13-3390-3_14

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