Mechanical Ventilation in Traumatic Brain Injury

Abstract

Background: Traumatic brain injury (TBI) is one of the leading causes of mortality and disability worldwide and frequently necessitates mechanical ventilation because of impaired consciousness, airway protection failure, respiratory insufficiency, and prevention of secondary brain injury. Mechanical ventilation plays a crucial role in maintaining adequate cerebral oxygenation and carbon dioxide balance; however, inappropriate ventilatory strategies may aggravate intracranial hypertension, impair cerebral perfusion, and contribute to pulmonary complications such as acute respiratory distress syndrome and ventilator-associated pneumonia. Lung-protective ventilation strategies, including low tidal volume, careful adjustment of positive end-expiratory pressure, and controlled oxygen supplementation, are increasingly recommended to optimize neurological and respiratory outcomes in TBI patients. In addition, strategies such as tracheostomy, prone positioning, and structured weaning protocols may influence duration of mechanical ventilation, ICU stay, and overall patient recovery. This review highlights current concepts and recent evidence regarding mechanical ventilation strategies, indications, settings, complications, and weaning approaches in traumatic brain injury patients managed in the intensive care unit.