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In 2026, authors Daniele Battaglini 🇮🇹, Chiara Robba 🇮🇹, and Nicola A. Patroniti 🇮🇹 published a review in "Current Opinion in Critical Care" discussing one of the most challenging topics in intensive care medicine: how to provide mechanical ventilation in patients with acute brain injury while simultaneously protecting the brain, the lungs, and the diaphragm.

Fonte: Battaglini D, Robba C, Patroniti NA. Curr Opin Crit Care. 2026 Feb 1;32(1):24-33. 

The authors review the physiological interactions between respiratory support and cerebral function, highlighting how ventilatory settings may influence intracranial pressure, cerebral perfusion, respiratory drive, diaphragm function, and clinical outcomes.

Key points summarized below:

🔹 Ultra-low tidal volumes may not be appropriate for all neurocritical patients, particularly when hypercapnia negatively affects cerebral physiology.

🔹 PaCO₂ remains a critical target, as both hypocapnia and hypercapnia can adversely impact cerebral blood flow and intracranial dynamics.

🔹 Moderate PEEP can often be safely applied, but its effects depend on cerebral compliance, intracranial pressure, and hemodynamic status.

🔹 Excessive suppression of respiratory drive may promote diaphragm dysfunction, whereas excessive inspiratory effort may worsen intracranial physiology.

🔹 Extubation failure in neurocritical patients is frequently driven by impaired airway protection, cough dysfunction, and neurological deficits rather than respiratory mechanics alone.

📖 Read the full article:

Mechanical ventilation in acute brain injured patients: balancing brain, lung, and diaphragm protection