Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Me
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CONFERENCE REPORTS AND EXPERT PANEL
Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus Chiara Robba1, Daniele Poole2, Molly McNett3, Karim Asehnoune4, Julian Bösel5,6, Nicolas Bruder7, Arturo Chieregato8, Raphael Cinotti9, Jacques Duranteau10, Sharon Einav11, Ari Ercole12, Niall Ferguson13,14, Claude Guerin15,16, Ilias I. Siempos17,18, Pedro Kurtz19, Nicole P. Juffermans20,21, Jordi Mancebo22, Luciana Mascia23, Victoria McCredie13, Nicolas Nin24, Mauro Oddo25, Paolo Pelosi1,26, Alejandro A. Rabinstein27, Ary Serpa Neto28,29, David B. Seder30, Markus B. Skrifvars31, Jose I. Suarez32,33,34, Fabio Silvio Taccone35, Mathieu van der Jagt36, Giuseppe Citerio37 and Robert D. Stevens32,33,34* © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Abstract Purpose: To provide clinical practice recommendations and generate a research agenda on mechanical ventilation and respiratory support in patients with acute brain injury (ABI). Methods: An international consensus panel was convened including 29 clinician-scientists in intensive care medicine with expertise in acute respiratory failure, neurointensive care, or both, and two non-voting methodologists. The panel was divided into seven subgroups, each addressing a predefined clinical practice domain relevant to patients admitted to the intensive care unit (ICU) with ABI, defined as acute traumatic brain or cerebrovascular injury. The panel conducted systematic searches and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to evaluate evidence and formulate questions. A modified Delphi process was implemented with four rounds of voting in which panellists were asked to respond to questions (rounds 1–3) and then recommendation statements (final round). Strong recommendation, weak recommendation, or no recommendation were defined when > 85%, 75–85%, and 20 mmHg when invasive monitoring was available, or as clinical or radiological signs of intracranial hypertension [10]. Articles were included in the analysis if they met the following criteria: studies of adults (> 18 years) admitted to the ICU with ABI, defined as above; clearly defined intervention and control groups; reported data on relevant outcome measures, such as clinical endpoints (survival, neurological or cognitive function, functional status) and/or physiological endpoints (intracranial pressure, cerebral oxygenation, cerebral blood flow, cerebral perfusion pressure, measures of lung function). Data from articles selected for full-text analysis were extracted using a standardized electronic form structured according to the population, intervention, comparison, and outcomes (PICO) model. Categorical variables were presented as event rates in treatment arms and controls, and absolute risks, absolute risk reductions, and relative risks computed. Continuous variables were reported as means or medians, standard deviation (SD) or interquartile ranges (IQR). Absolute and relative r
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