Seder D B, Bösel J
Department of Critical Care Services, Maine Medical Center, Portland, ME, USA; Tufts University School of Medicine, Boston, MA, USA.
Department of Neurology, University of Heidelberg, Heidelberg, Germany.
Handb Clin Neurol. 2017;140:15-32. doi: 10.1016/B978-0-444-63600-3.00002-7.
Patients with acute neurologic disease often develop respiratory failure, the management of which profoundly affects brain physiology and long-term functional outcomes. This chapter reviews airway management and mechanical ventilation of patients with acute brain injury, offering practical strategies to optimize treatment of respiratory failure and minimize secondary brain injury. Specific concerns that are addressed include physiologic changes during intubation and ventilation such as the effects on intracranial pressure and brain perfusion; cervical spine management during endotracheal intubation; the role of tracheostomy; and how ventilation and oxygenation are utilized to minimize ischemia-reperfusion injury and cerebral metabolic distress.
急性神经疾病患者常发生呼吸衰竭，其管理对脑生理学和长期功能结局有深远影响。本章回顾急性脑损伤患者的气道管理和机械通气，提供优化呼吸衰竭治疗及最小化继发性脑损伤的实用策略。涉及的具体问题包括插管和通气期间的生理变化，如对颅内压和脑灌注的影响；气管插管期间的颈椎管理；气管切开术的作用；以及如何利用通气和氧合来最小化缺血再灌注损伤和脑代谢窘迫。
