An integrated approach to prevent and treat respiratory failure in brain-injured patients.
OBJECTIVE
Brain-injured patients are at increased risk of extracerebral organ dysfunction, in particular ventilator-associated pneumonia. The purpose of this review is to discuss functional abnormalities, clinical treatment, and possible prevention of respiratory function abnormalities in brain-injured patients.


RESULTS
Ventilator-associated pneumonia worsens the neurologic outcome and increases the intensive care unit and hospital stay, costs, and risk of death. The respiratory dysfunction can be due to several causes, but atelectasis and/or consolidation of the lower lobes predominates in the most severe cases. Strategies should be implemented to prevent lung infections and accelerate weaning from mechanical ventilation to reduce the incidence of respiratory dysfunction and ventilator-associated pneumonia.


CONCLUSIONS
An integrated approach including appropriate ventilatory, antibiotic, and fluid management could be extremely useful, not only to prevent and more rapidly treat respiratory failure but also to improve neurologic outcome and reduce hospital stay. Further studies are warranted to better elucidate the pathophysiology and clinical treatment of respiratory dysfunction in brain-injured patients.
Pelosi
Paolo
P
Dipartimento Ambiente, Salute e Sicurezza, Universita' degli Studi dell'Insubria, Servizio di Anestesia e Rianimazione B, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. ppelosi@hotmail.com
Severgnini
Paolo
P
Chiaranda
Maurizio
M
D001930:Brain Injuries / Q000150:complications*; D003422:Critical Care / Q000379:methods; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology / Q000517:prevention & control; D011654:Pulmonary Edema / Q000209:etiology; D012120:Respiration Disorders / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D012141:Respiratory Tract Infections / Q000209:etiology / Q000517:prevention & control; D014692:Ventilation-Perfusion Ratio; D015300:Ventilator Weaning / Q000379:methods