Ventilatory Strategies in the Brain-injured Patient

Although the interactions between the brain and lungs may not be as intuitively obvious as those between the heart and lungs, the neurological and pulmonary systems share a physiological interdependence that plays a role in the pathologic states of either system. This often underrecognized interdependence may lead to significant challenges in the perioperative management of patients with brain or lung injury. At times, the parallel goals of ensuring adequate brain tissue oxygenation and providing a lungprotective ventilation strategy may seem at odds with one another. Does a lung-protective ventilation strategy, which includes low tidal volumes and optimal levels of positive end-expiratory pressure (PEEP), confer similar benefits to brain-injured patients, as it does for patients without brain injury? Can this strategy of mechanical ventilation be safely applied without adversely affecting cerebral hemodynamics? In this chapter, we will explore these questions and provide a practical framework for managing mechanical ventilation in brain-injured patients.