UMEM Educational Pearls

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Title: Mechanical Ventilation of the Patient with Acute Ischemic Stroke

Category: Critical Care

Posted: 1/21/2020 by Mike Winters, MBA, MD

Mechanical Ventilation Pearls for Acute Ischemic Stroke

Patients with an acute ischemic stroke (AIS) may require intubation for various reasons.
Two main goals of mechanical ventilation in patients with an AIS are to maintain appropriate oxygen levels and tight control of PaCO2.
In terms of oxygenation:
- Target normoxia
- Administer O2 if the SpO2 is < 94%
- Supplemental O2 is not recommended in non-hypoxic patients
In terms of CO2:
- Target normocapnia
- Hypercapnia increases the risk of intracranial hypertension
- Hypocapnia can worsen cerebral perfusion

Robba C, et al. Mechanical ventilation in patients with acute ischemic stroke: from pathophysiology to clinical practice. Crit Care. 2019;23:388.