Köksal Güniz M, Akyol Beyoğlu Çiğdem, El-Khatib Mohamad, Gómez-Ríos Manuel Á, Papadakos Peter, Esquinas Antonio M
Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.
Department of Anaesthesiology and Reanimation, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey.
Turk J Anaesthesiol Reanim. 2023 Apr;51(2):80-84. doi: 10.5152/TJAR.2023.21116.
Non-invasive ventilation application in neurocritical care with risk of pneumocephalus is controversial. Non-invasive ventilation-related increased intrathoracic pressure increases intracranial pressure via direct transmission of intrathoracic pressure to the intracranial cavity. In addition, increased thoracic pressure decreases venous return to the heart and increases vena jugularis interna pressure, thereby increasing cerebral blood volume. Pneumocephalus is one of the major concerns after non-invasive ventilation application in head/brain trauma patients. Non-invasive mechanical ventilation may be performed in limited conditions in head trauma/brain surgery with appropriate and close monitoring. High-flow nasal cannula oxygen therapy can provide higher FiO2 as manifested by a larger increase in PaO2/FiO2 ratio and provide the theoretical basis in pneumocephalus because augmenting the PaO2 more effectively would accelerate nitrogen (N2) washout. As a result, non-invasive mechanical ventilation may be performed in limited manner in head trauma/ brain surgery with appropriate and close monitoring.
无创通气在有发生气颅风险的神经重症监护中的应用存在争议。无创通气相关的胸内压升高通过胸内压直接传递至颅内腔而增加颅内压。此外，胸内压升高会减少心脏的静脉回流并增加颈内静脉压力，从而增加脑血容量。气颅是无创通气应用于头部/脑部创伤患者后的主要担忧之一。在头部创伤/脑外科手术中，在适当且密切监测的有限条件下可进行无创机械通气。高流量鼻导管给氧疗法可提供更高的FiO2，表现为PaO2/FiO2比值有更大幅度的升高，并为气颅提供理论依据，因为更有效地提高PaO2会加速氮气（N2）清除。因此，在头部创伤/脑外科手术中，在适当且密切监测的情况下，可有限度地进行无创机械通气。
