Combined lung and brain ultrasonography for an individualized "brain-protective ventilation strategy" in neurocritical care patients with challenging ventilation needs.

IF 3.6 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Francesco Corradi, Chiara Robba, Guido Tavazzi, Gabriele Via
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引用次数: 14

Abstract

When intracranial hypertension and severe lung damage coexist in the same clinical scenario, their management poses a difficult challenge, especially as concerns mechanical ventilation management. The needs of combined lung and brain protection from secondary damage may conflict, as ventilation strategies commonly used in patients with ARDS are potentially associated with an increased risk of intracranial hypertension. In particular, the use of positive end-expiratory pressure, recruitment maneuvers, prone positioning, and protective lung ventilation can have undesirable effects on cerebral physiology: they may positively or negatively affect intracranial pressure, based on the final repercussions on PaO2 and cerebral perfusion pressure (through changes in cardiac output, mean arterial pressure, venous return, PaO2 and PaCO2), also according to the baseline conditions of cerebral autoregulation. Lung ultrasound (LUS) and brain ultrasound (BUS, as a combination of optic nerve sheath diameter assessment and cerebrovascular Doppler ultrasound) have independently proven their potential in respectively monitoring lung aeration and brain physiology at the bedside. In this narrative review, we describe how the combined use of LUS and BUS on neurocritical patients with demanding mechanical ventilation needs can contribute to ventilation management, with the aim of a tailored "brain-protective ventilation strategy."

Abstract Image

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肺和脑联合超声检查对具有挑战性通气需求的神经危重症患者的个性化“脑保护性通气策略”。
当颅内高压和严重肺损伤同时存在于同一临床场景时,其处理提出了困难的挑战,特别是在机械通气管理方面。由于ARDS患者常用的通气策略可能与颅内高压风险增加相关,因此肺和脑联合保护免受继发性损伤的需求可能会发生冲突。特别是,使用呼气末正压、复吸动作、俯卧位和保护性肺通气会对脑生理产生不良影响:根据对PaO2和脑灌注压的最终影响(通过心输出量、平均动脉压、静脉回流、PaO2和PaCO2的变化),也根据脑自动调节的基线条件,它们可能会对颅内压产生积极或消极的影响。肺超声(LUS)和脑超声(BUS)作为视神经鞘直径评估和脑血管多普勒超声的结合,分别在床边监测肺通气和脑生理方面具有独立的潜力。在这篇叙述性综述中,我们描述了LUS和BUS联合应用于有机械通气需求的神经危重症患者如何有助于通气管理,目的是制定量身定制的“脑保护通气策略”。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Critical Ultrasound Journal
Critical Ultrasound Journal RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
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13 weeks
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