Respiratory Management for Traumatic Brain Injury: Difference between revisions
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== Respiratory Assessment of TBI Patient == | == Respiratory Assessment of TBI Patient == | ||
=== Medical Information === | === Medical Information === | ||
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* respiratory patterns | * respiratory patterns | ||
* pulmonary function testing | * pulmonary function testing | ||
* peak cough flow | |||
=== Past Respiratory History === | |||
This will frequently be provided by family members in cases of acute and severe TBI. The therapist should inquire about any previous respiratory conditions, as well as smoking history.<div align="justify"> | |||
<div align="justify"> | |||
=== General Observation === | === General Observation === | ||
The therapist will watch the patient and note the general respiratory pattern and posture; whether there is any cyanosis or accessory muscle use, as well as noting speech patterns if appropriate.<div align="justify"> | The therapist will watch the patient and note the general respiratory pattern and posture; whether there is any cyanosis or accessory muscle use, as well as noting speech patterns if appropriate. | ||
==== Respiratory Pattern Ax ==== | |||
This includes breathing rate, depth of breaths, symmetry of air intake/lung expansion, regularity of breaths. | |||
==== Other Ax techniques ==== | |||
Percussion is used to detect chest resonance. Percussion applied to the patient's chest produces audible sounds which can be interpreted by a skilled examiner to discern fluid, air or solid material within the chest cavity<ref>Hough, A. 1996. Physiotherapy in Respiratory Care. 2nd ed. Chapman and Hall, London</ref>. Please see the [https://www.physio-pedia.com/Respiratory_Assessment-_Percussion Respiratory Assessment - Percussion] page for further information, including a description of technique.<div align="justify"> | |||
<div align="justify"><div align="justify"> | |||
== Respiratory Management == | == Respiratory Management == | ||
In the acute stages of TBI, the aims of management in the Intensive Care Unit are to maintain oxygen delivery in order to limit secondary neurological damage. Mechanical ventilation is commonly used with 3 aims: 1. To prevent/minimise hypoxia 2. To prevent/minimise hypercapnia 3. To protect the airway from risk of aspiration. It is acknowledged that difficulties are frequently encountered when weaning these patients from mechanical ventilation<ref>Coplin WM, Pierson DJ, Cooley KD, et al. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med. 2000;161:1530–6.</ref>. A number of recent studies have investigated the use of protective ventilation in the early stages following TBI<ref>Asehnoune K, Seguin P, Lasocki S, et al. Extubation success prediction in a multicentric cohort of patients with severe brain injury. Anesthesiology. 2017;127:338–46.</ref><ref>Godet T, Chabanne R, Marin J, et al. Extubation failure in brain-injured patients: risk factors and development of a prediction score in a preliminary prospective cohort study. Anesthesiology. 2017;126:104–14.</ref>. | In the acute stages of TBI, the aims of management in the Intensive Care Unit are to maintain oxygen delivery in order to limit secondary neurological damage. Mechanical ventilation is commonly used with 3 aims: 1. To prevent/minimise hypoxia 2. To prevent/minimise hypercapnia 3. To protect the airway from risk of aspiration. It is acknowledged that difficulties are frequently encountered when weaning these patients from mechanical ventilation<ref>Coplin WM, Pierson DJ, Cooley KD, et al. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med. 2000;161:1530–6.</ref>. A number of recent studies have investigated the use of protective ventilation in the early stages following TBI<ref>Asehnoune K, Seguin P, Lasocki S, et al. Extubation success prediction in a multicentric cohort of patients with severe brain injury. Anesthesiology. 2017;127:338–46.</ref><ref>Godet T, Chabanne R, Marin J, et al. Extubation failure in brain-injured patients: risk factors and development of a prediction score in a preliminary prospective cohort study. Anesthesiology. 2017;126:104–14.</ref>. | ||
Revision as of 23:24, 29 July 2019
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Original Editor - Wendy Walker
Top Contributors - Wendy Walker, Kim Jackson, Naomi O'Reilly, Tarina van der Stockt, Rachael Lowe, Simisola Ajeyalemi, Uchechukwu Chukwuemeka, Lucinda hampton, Eugenie Lamprecht and Stacy Schiurring
Introduction[edit | edit source]
In cases of Traumatic Brain Injury [TBI] respiratory dysfunction is the most common medical complication which occurs[1][2].
Up to one third of patients with severe TBI develop Acute Respiratory Distress Syndrome [ARDS][3][4].
There is a reciprocal relationship between lung function and brain function: the brain needs sufficient oxygen supply in order to operate, and the respiratory system needs instructions from the brain in order to operate.
Respiratory Assessment of TBI Patient[edit | edit source]
Medical Information[edit | edit source]
The respiratory physiotherapist should pay close attention to the following information when assessing a patient with TBI in the acute situation:
- arterial blood gases
- chest x-rays
- respiratory patterns
- pulmonary function testing
- peak cough flow
Past Respiratory History[edit | edit source]
This will frequently be provided by family members in cases of acute and severe TBI. The therapist should inquire about any previous respiratory conditions, as well as smoking history.General Observation[edit | edit source]
The therapist will watch the patient and note the general respiratory pattern and posture; whether there is any cyanosis or accessory muscle use, as well as noting speech patterns if appropriate.
Respiratory Pattern Ax[edit | edit source]
This includes breathing rate, depth of breaths, symmetry of air intake/lung expansion, regularity of breaths.
Other Ax techniques[edit | edit source]
Percussion is used to detect chest resonance. Percussion applied to the patient's chest produces audible sounds which can be interpreted by a skilled examiner to discern fluid, air or solid material within the chest cavity[5]. Please see the Respiratory Assessment - Percussion page for further information, including a description of technique.Respiratory Management[edit | edit source]
In the acute stages of TBI, the aims of management in the Intensive Care Unit are to maintain oxygen delivery in order to limit secondary neurological damage. Mechanical ventilation is commonly used with 3 aims: 1. To prevent/minimise hypoxia 2. To prevent/minimise hypercapnia 3. To protect the airway from risk of aspiration. It is acknowledged that difficulties are frequently encountered when weaning these patients from mechanical ventilation[6]. A number of recent studies have investigated the use of protective ventilation in the early stages following TBI[7][8].
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ Solenski NJ, Haley EC, Kassell NF, Kongable G, Germanson T, Truskowski L, Torner JC. Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study. Crit Care Med. 1995;23:1007–1017.
- ↑ Plötz FB, Slutsky AS, van Vught AJ, Heijnen CJ. Ventilator-induced lung injury and multiple system organ failure: a critical review of facts and hypotheses. Intensive Care Med. 2004;30:1865–1872.
- ↑ Holland MC, Mackersie RC, Morabito D, Campbell AR, Kivett VA, Patel R, Erickson VR, Pittet JF. The development of acute lung injury is associated with worse neurologic outcome in patients with severe traumatic brain injury. J Trauma. 2003;55:106–111.
- ↑ Kahn JM, Caldwell EC, Deem S, Newell DW, Heckbert SR, Rubenfeld GD. Acute lung injury in patients with subarachnoid hemorrhage: incidence, risk factors, and outcome. Crit Care Med. 2006;34:196–202.
- ↑ Hough, A. 1996. Physiotherapy in Respiratory Care. 2nd ed. Chapman and Hall, London
- ↑ Coplin WM, Pierson DJ, Cooley KD, et al. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med. 2000;161:1530–6.
- ↑ Asehnoune K, Seguin P, Lasocki S, et al. Extubation success prediction in a multicentric cohort of patients with severe brain injury. Anesthesiology. 2017;127:338–46.
- ↑ Godet T, Chabanne R, Marin J, et al. Extubation failure in brain-injured patients: risk factors and development of a prediction score in a preliminary prospective cohort study. Anesthesiology. 2017;126:104–14.
