title: Optimizing Outcomes for Mechanically Ventilated Patients in an Era of Endovascular Acute Ischemic Stroke Therapy.
abstract: Endovascular mechanical thrombectomy is a new standard of care for acute ischemic stroke (AIS). The majority of these patients receive mechanical ventilation (MV), which has been associated with poor outcomes. The implication of this is significant, as most neurointerventionalists prefer general compared to local anesthesia during the procedure. Consequences of hemodynamic and respiratory perturbations during general anesthesia and MV are thought to contribute significantly to the poor outcomes that are encountered. In this review, we first describe the unique risks associated with MV in the specific context of AIS and then discuss evidence of brain goal-directed approaches that may mitigate these risks. These strategies include an individualized approach to hemodynamic parameters (eg, adherence to a minimum blood pressure goal and adequate volume resuscitation), respiratory parameters (eg, arterial carbon dioxide optimization), and the use of ventilator settings that optimize neurological outcomes (eg, arterial oxygen optimization).
authors.affiliation: 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.|2 Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Shouri
authors.initials: S
authors.lastname: Lahiri
authors.affiliation: 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Konrad
authors.initials: K
authors.lastname: Schlick
authors.affiliation: 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Tapan
authors.initials: T
authors.lastname: Kavi
authors.affiliation: 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Shlee
authors.initials: S
authors.lastname: Song
authors.affiliation: 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.|2 Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Asma M
authors.initials: AM
authors.lastname: Moheet
authors.affiliation: 3 Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Taizoon
authors.initials: T
authors.lastname: Yusufali
authors.affiliation: 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.|2 Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Axel
authors.initials: A
authors.lastname: Rosengart
authors.affiliation: 2 Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Alexander
authors.affiliation: 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Lyden
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume / Q000502:physiology; D002545:Brain Ischemia / Q000503:physiopathology / Q000601:surgery*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D012121:Respiration, Artificial / Q000009:adverse effects; D020521:Stroke / Q000503:physiopathology / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods
chemical_list: D005343:Fibrinolytic Agents
keywords: acute ischemic stroke; endovascular management; mechanical ventilation; thrombectomy