title: High-frequency oscillatory ventilation with tracheal gas insufflation: the rescue strategy for brain-lung interaction.
abstract: The occurrence of moderate to severe acute respiratory distress syndrome due to traumatic brain injury is not uncommon and is associated with an extremely high incidence of morbidity and mortality. Owing to the complex interaction between the lung and brain, protective ventilation for the lung with lower tidal volume and higher positive end-expiratory pressure with or without mild hypercapnia might be harmful for the brain, and maintaining normocapnia or mild hypocapnia by increasing tidal volume or respiratory rate (or both) with lower positive end-expiratory pressure levels for protecting the brain might lead to ventilator-induced lung injury. Balancing the end-point between lungs and brain becomes a challenging issue, and non-conventional modes of mechanical ventilation might play a role in the more difficult clinical cases. In this commentary, the authors discuss the rationale, based on the physiologic principle of targeting both vital organs, of applying high-frequency oscillation and tracheal gas insufflation in acute respiratory distress syndrome patients with traumatic brain injury.
authors: Paolo
authors: P
authors: Pelosi
authors: Yuda
authors: Y
authors: Sutherasan
mesh_terms: D001930:Brain Injuries / Q000150:complications* / Q000628:therapy*; D005260:Female; D006612:High-Frequency Ventilation; D006801:Humans; D007327:Insufflation; D008297:Male; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000628:therapy*
references: Curr Opin Crit Care. 2005 Feb;11(1):37-42
references: 15659943
references: Intensive Care Med. 2011 Jul;37(7):1182-91
references: 21544692
references: Intensive Care Med. 2011 Jun;37(6):990-9
references: 21369813
references: N Engl J Med. 2013 Feb 28;368(9):795-805
references: 23339639
references: Crit Care. 2013 Jul 11;17(4):R136
references: 23844839
references: J Neurotrauma. 2007;24 Suppl 1:S1-106
references: 17511534
references: Crit Care Med. 2007 Jun;35(6):1500-8
references: 17440419
references: J Trauma. 2005 Jun;58(6):1294-7
references: 15995487
references: JAMA. 2012 Oct 24;308(16):1651-9
references: 23093163
references: Crit Care. 2011;15(3):R124
references: 21569477
references: Crit Care Med. 2007 Aug;35(8):1815-20
references: 17568331
references: Eur Respir J. 2012 Mar;39(3):635-47
references: 21885390
references: Crit Care. 2011;15(3):168
references: 21722336
references: Br J Anaesth. 2007 Jul;99(1):32-42
references: 17556349
references: N Engl J Med. 2013 Feb 28;368(9):806-13
references: 23339638