Mechanical Ventilation After Neurosurgery

Abstract

Neurosurgical patients are at high risk for requiring mechanical ventilator support. This complex and heterogeneous population are at high risk for airway compromise from mechanical airway obstruction from either direct trauma, cervical spine injury with laryngeal edema, or obtundation with airway obstruction from complete or intermittent soft tissue collapse, situations similar to respiratory failure with stridor or apnea from airway obstruction. Neurosurgical patients are at extremely high risk for secondary brain injury from hypercapnia or hypoxemia because of risks for intracranial hypertension, local cerebral ischemia, and brain herniation. Brain–lung interactions can precipitate systemic inflammatory response and result in ALI or ARDS requiring escalating levels of ventilator support including PEEP and Open Lung ventilator strategies. Until recently, mechanical ventilation in this complex population has been guided mainly by opinion; multimodality cerebral monitoring is increasingly allowing mechanical ventilator and hemodynamic support to be titrated to measureable cerebral physiologic and biochemical endpoints.