Although direct data to guide mechanical ventilation in brain-injured patients is accumulating, the current evidence base remains limited.

Ventilatory considerations in this population should be extrapolated from high-quality evidence in patients without brain injury – keeping in mind relevant effects on intracranial pressure and cerebral perfusion in patients with acute brain injury (ABI) and individualizing the chosen strategy to manage brain-lung conflicts where necessary.

Physiologic studies have elucidated the impact of low tidal volume ventilation and varying levels of positive end expiratory pressure on intracranial pressure and cerebral perfusion.

Epidemiologic studies have reported the association of different thresholds of tidal volume, plateau pressure, driving pressure, mechanical power, and arterial oxygen and carbon dioxide concentrations with mortality and neurologic outcomes in patients with ABI.

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