title: Mechanical Ventilation during Acute Brain-Injury in Children.
abstract: Mechanical ventilation in the brain-injured pediatric patient requires many considerations, including the type and severity of lung and brain injury and how progression of such injury will develop. This review focuses on neurological breathing patterns at presentation, the effect of brain injury on the lung, developmental aspects of blood gas tensions on cerebral blood flow, and strategies used during mechanical ventilation in infants and children receiving neurological intensive care. Taking these basic principles, our clinical approach is informed by balancing the blood gas tension targets that follow from the ventilation support we choose and the intracranial consequences of these choices on vascular and hydrodynamic physiology. As such, we are left with two key decisions: a low tidal volume strategy for the lung versus the consequence of hypercapnia on the brain; and the use of positive end expiratory pressure to optimize oxygenation versus the consequence of impaired cerebral venous return from the brain and resultant intracranial hypertension.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine.
authors.forename: Jordan S
authors.initials: JS
authors.lastname: Rettig
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Duncan
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine; Department of Neurology; Boston Children's Hospital and Harvard Medical School, Boston, MA. Electronic address: robert.tasker@childrens.harvard.edu.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Tasker
mesh_terms: D000208:Acute Disease; D001930:Brain Injuries / Q000628:therapy*; D002648:Child; D006801:Humans; D012121:Respiration, Artificial / Q000379:methods*; D016896:Treatment Outcome
keywords: Acute lung injury; Brain injury; Intracranial pressure; Neurogenic pulmonary edema; Pediatric; Permissive hypercapnia