This narrative review focuses on the information specific to stroke patients that do not have brain trauma or intracranial pressure issues, including the concern over the need for tracheostomy as an intervention to prevent aspiration pneumonia rather than for primarily pulmonary issues. Disagreements were resolved by discussion and consensus agreement and, if required, input from a third author (DB). Titles and abstracts were retrieved and independently assessed for eligibility by two authors (CR, GB). For this purpose, we performed a literature search of four electronic databases (PubMED, Scopus, ScienceDirect, Web of Science), using the following terms: “mechanical ventilation” and “stroke”. The aim of this manuscript is to review and describe the pathophysiology underlying the development of pulmonary complications and respiratory failure after AIS and the different ventilator strategies in this population, focusing on the risk related to oxygen (O 2) therapy and the application of protective lung ventilation. So far, few studies have addressed the best respiratory management of patients with AIS. Since the most frequent extra-cerebral complication of neurological ICU patients is respiratory failure, the development of new mechanical ventilation strategies may potentially improve their outcome. In particular, stroke-associated pneumonia (SAP) is described as an independent risk factor for unfavourable outcome and death. Pulmonary complications-such as respiratory failure, pneumonia, pleural effusion, acute respiratory distress syndrome (ARDS), pulmonary oedema, and pulmonary embolism from venous thromboembolism-may occur in this group of patients and are associated with a high risk of mortality. In this context, impairment of the brain areas that regulate the level of consciousness (thalami, the limbic system, the reticular formation in the brainstem), breathing (respiratory centres in the cortex, pons, and medulla), and swallowing (medulla and brainstem connections) increases the risk of respiratory failure. The location of the stroke is probably the most relevant factor related to the need for mechanical ventilation (MV), rather than the particular type of cerebrovascular pathology. Approximately 80% of all strokes are ischaemic other major types include intracerebral (ICH) and intraventricular (IVH) haemorrhage, cerebral venous and sinus thrombosis, and subarachnoid haemorrhage (SAH) secondary to aneurysm leak or rupture. Over the last decades, the incidence of stroke has been increasing, and despite an overall decrease in mortality, it is still the leading cause of severe disability in the adult population. The aim of this narrative review is to explore the pathophysiology of brain-lung interactions after acute ischaemic stroke and the management of mechanical ventilation in these patients.Īcute ischaemic stroke (AIS) is one of the major causes of morbidity and mortality worldwide and one of the leading causes for admission to neurological intensive care units (NICUs). Although a high tidal volume ( V T) strategy has been used for many years, the latest evidence suggests that a protective ventilatory strategy ( V T = 6–8 mL/kg predicted body weight, positive end-expiratory pressure and rescue recruitment manoeuvres) may also have a role in brain-damaged patients, including those with stroke. However, the optimal mechanical ventilator strategy remains unclear in this population. Furthermore, over the past two decades, tracheostomy use has increased among stroke patients, who can have unique indications for this procedure-depending on the location and type of stroke-when compared to the general population.

Pulmonary complications, such as respiratory failure, pneumonia, pleural effusions, acute respiratory distress syndrome, lung oedema, and pulmonary embolism from venous thromboembolism, are common and found to be among the major causes of death in this group of patients. Experimental studies have focused on stroke-induced immunosuppression and brain-lung crosstalk, leading to increased pulmonary damage and inflammation, as well as reduced alveolar macrophage phagocytic capability, which may increase the risk of infection. Mechanical ventilation is frequently performed in these patients due to swallowing dysfunction and airway or respiratory system compromise. Most patients with ischaemic stroke are managed on the ward or in specialty stroke units, but a significant number requires higher-acuity care and, consequently, admission to the intensive care unit.

Normal tidal volume for clin sims