Airway Management in Patients With Acute Brain Injury or Ischemia.
The Journal of emergency medicine January 6, 2025 Jake Hoyne, Jonathan Edlow 7 citations
Endotracheal intubation in patients with acute brain injury or ischemia carries a risk of secondary brain injury if not performed with caution. Before intubation, avoiding extremes in blood pressure, preoxygenating, and managing elevated intracranial pressure are critical. During intubation, using a hemodynamically neutral induction agent like ketamine or etomidate minimizes hypotension; ketamine, once avoided, is now considered acceptable as it does not affect cerebral perfusion pressure. Video laryngoscopy is recommended. After intubation, ventilator settings should target eucapnia, and adequate sedation helps manage intracranial pressure. EEG monitoring can detect non-convulsive status epilepticus. These evidence-based practices aim to minimize secondary brain injury and improve outcomes.