Liberation of neurosurgical patients from mechanical ventilation and tracheostomy in neurocritical care

• Published in: Journal of critical care Vol. 27; no. 4; pp. 417.e1 - 417.e8
• Main Authors: Lazaridis, Christos, MD, DeSantis, Stacia M., PhD, McLawhorn, Marc, MS, Krishna, Vibhor, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2012; Elsevier Limited
• Subjects: Airway Extubation - methods; Anesthesia; Brain damage; Brain Injuries - therapy; Brain injury; Confidence intervals; Critical Care; Critical Care - methods; Extubation; Health Status Indicators; Hospitals; Humans; Mechanical ventilation; Mortality; Ostomy; Primaries & caucuses; Respiratory therapy; Risk Assessment; Studies; Task forces; Time Factors; Tracheostomy - methods; Ventilator liberation; Ventilator Weaning - methods; Weaning; Mechanical ventilation; Brain injury; Extubation; Ventilator liberation
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2011.08.018

Abstract Neurosurgical patients commonly require mechanical ventilation and monitoring in a neurocritical care unit. There are only few studies that specifically address the process of liberation from mechanical ventilation in this population. Patients who remain ventilator or artificial airway dependent receive a tracheostomy. The appropriate timing for the procedure is not well defined and may be different among an inhomogeneous population of critically ill patients. In this article, we review the general principles of liberation and the current literature as it pertains to neurosurgical patients with primary brain injury. The criteria for “readiness of extubation” include a combination of neurologic assessment, hemodynamic, and respiratory parameters. Future studies are required to better assess indicators for extubation readiness, evaluate the predictors of extubation failure in brain-injured patients, and define the most appropriate timing for a tracheostomy.