title: Mechanical ventilation in neurocritical care patients: a systematic literature review.
abstract: Neurocritical care (NCC) patients often require prolonged mechanical ventilation, and they are at high risk of respiratory complications. Therefore, the potential benefit role of protective lung ventilation (PLV), which demonstrated to reduce postoperative complications in patients with acute distress respiratory syndrome, has been suggested even on NCC patients. However, PLV can increase intracranial pressure as result of permissive hypercapnia and of high airway pressures during recruitment maneuvers. The aim of this review (PROSPERO registration number: CRD42015027011) is to describe the ventilatory strategies, and in particular PLV, commonly used in NCC patients.
  
  
  
  We selected a total of 16 clinical studies, searching on PubMed and EMBASE databases, reporting original information on the MV on patients receiving NCC after acute brain injury, published in the last 10 years, in English language. Some of the included studies report data on a limited sample size. Expert commentary: The use of PLV techniques (PEEP, recruitment maneuvers, etc) in NCC patients is controversial. There is a wide variability among different centers in the treatment strategies and respiratory management of NCC patients, and there is the need for shared diagnostics and therapeutic studies, in order to improve the patients' outcome.
authors.affiliation: a Department of Anaesthesiology, Critical Care and Pain Medicine , University of Rome 'La Sapienza' , Rome , Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Borsellino
authors.affiliation: b Department of Intensive Care , Academic Medical Center , Amsterdam , The Netherlands.
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
authors.affiliation: c Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group , University Hospital Dresden, Technische Universität Dresden , Dresden , Germany.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Gama de Abreu
authors.affiliation: d Neurocritical Care Unit, Addenbrookes Hospital , University of Cambridge , Cambridge , UK.
authors.forename: Chiara
authors.initials: C
authors.lastname: Robba
authors.affiliation: a Department of Anaesthesiology, Critical Care and Pain Medicine , University of Rome 'La Sapienza' , Rome , Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Bilotta
mesh_terms: D003422:Critical Care; D006801:Humans; D009422:Nervous System Diseases / Q000150:complications / Q000628:therapy*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000628:therapy*
keywords: Acute respiratory distress syndrome; intracranial pressure; neurocritical care; protective ventilation; recruitment maneuvers