Ventilation Strategy and the Time of Tracheotomy: A Different Approach in Trauma?

Traumatic brain injury (TBI) is a leading cause of mortality and disability worldwide. Tracheal intubation and invasive mechanical ventilation are frequently utilized in severe TBI to protect the airways from aspiration and to prevent secondary insults to the injured brain, such as hypoxemia and hypercapnia. Moreover, during intensive care unit (ICU) stay, brain injured patients often develop severe respiratory failure and acute respiratory distress syndrome (ARDS). The management of patients with concurrent TBI and acute respiratory failure is a challenging scenario requiring an adequate pathophysiological knowledge. This chapter focuses, in a practical way, on the principles of invasive mechanical ventilation and tracheotomy practice in TBI patients with and without concurrent respiratory failure.