Neurocritical Care

, Volume 17, Supplement 1, pp 4–20 | Cite as

Emergency Neurological Life Support: Airway, Ventilation, and Sedation

  • David B. Seder
  • Richard R. Riker
  • Andy Jagoda
  • Wade S. Smith
  • Scott D. Weingart
Review Article


Airway management is central to the resuscitation of the neurologically ill. These patients often have evolving processes that threaten the airway and adequate ventilation. Therefore, airway, ventilation, and sedation were chosen as an Emergency Neurological Life Support (ENLS) protocol. Reviewed topics include airway management; the decision to intubate; when and how to intubate with attention to cardiovascular status; mechanical ventilation settings; and the use of sedation, including how to select sedative agents based on the patient’s neurological status.


Respiratory failure Airway protection Intubation Ventilation 


  1. 1.
    Davis DP, Dunford JV, Ochs M, Park K, Hoyt DB. The use of quantitative end-tidal capnometry to avoid inadvertent severe hyperventilation in patients with head injury after paramedic rapid sequence intubation. J Trauma. 2004;56:808–14.CrossRefPubMedGoogle Scholar
  2. 2.
    Coplin WM, Pierson DJ, Cooley KD, Newell DW, Rubenfeld GD. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med. 2000;161:1530–6.PubMedGoogle Scholar
  3. 3.
    Walls RM, Murphy MF. Manual of emergency airway management. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2008.Google Scholar
  4. 4.
    Sagarin MJ, Barton ED, Chng YM, Walls RM. National Emergency Airway Registry I. Airway management by US and Canadian emergency medicine residents: a multicenter analysis of more than 6,000 endotracheal intubation attempts. Ann Emerg Med. 2005;46:328–36.CrossRefPubMedGoogle Scholar
  5. 5.
    Li J, Murphy-Lavoie H, Bugas C, Martinez J, Preston C. Complications of emergency intubation with and without paralysis. Am J Emerg Med. 1999;17:141–3.CrossRefPubMedGoogle Scholar
  6. 6.
    Sakles JC, Laurin EG, Rantapaa AA, Panacek EA. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med. 1998;31:325–32.CrossRefPubMedGoogle Scholar
  7. 7.
    Walls RM. Rapid-sequence intubation in head trauma. Ann Emerg Med. 1993;22:1008–13.CrossRefPubMedGoogle Scholar
  8. 8.
    Bedford RF, Persing JA, Pobereskin L, Butler A. Lidocaine or thiopental for rapid control of intracranial hypertension? Anesth Analg. 1980;59:435–7.PubMedGoogle Scholar
  9. 9.
    Gabriel EJ, Ghajar J, Jagoda A, et al. Guidelines for prehospital management of traumatic brain injury. J Neurotrauma. 2002;19:111–74.CrossRefPubMedGoogle Scholar
  10. 10.
    Weingart S. Additional thoughts on the controversy of lidocaine administration before rapid sequence intubation in patients with traumatic brain injuries. Ann Emerg Med. 2007;50:353.CrossRefPubMedGoogle Scholar
  11. 11.
    Salhi B, Stettner E. In defense of the use of lidocaine in rapid sequence intubation. Ann Emerg Med. 2007;49:84–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Feng CK, Chan KH, Liu KN, Or CH, Lee TY. A comparison of lidocaine, fentanyl, and esmolol for attenuation of cardiovascular response to laryngoscopy and tracheal intubation. Acta Anaesthesiol Sin. 1996;34:61–7.PubMedGoogle Scholar
  13. 13.
    Reynolds SF, Heffner J. Airway management of the critically ill patient: rapid-sequence intubation. Chest. 2005;127:1397–412.CrossRefPubMedGoogle Scholar
  14. 14.
    Bergen JM, Smith DC. A review of etomidate for rapid sequence intubation in the emergency department. J Emerg Med. 1997;15:221–30.CrossRefPubMedGoogle Scholar
  15. 15.
    Moss E, Powell D, Gibson RM, McDowall DG. Effect of etomidate on intracranial pressure and cerebral perfusion pressure. Br J Anaesth. 1979;51:347–52.CrossRefPubMedGoogle Scholar
  16. 16.
    Hug CC Jr, McLeskey CH, Nahrwold ML, et al. Hemodynamic effects of propofol: data from over 25,000 patients. Anesth Analg. 1993;77:S21–9.PubMedGoogle Scholar
  17. 17.
    Bar-Joseph G, Guilburd Y, Tamir A, Guilburd JN. Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension. J Neurosurg Pediatr. 2009;4:40–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Langsjo JW, Maksimow A, Salmi E, et al. S-ketamine anesthesia increases cerebral blood flow in excess of the metabolic needs in humans. Anesthesiology. 2005;103:258–68.CrossRefPubMedGoogle Scholar
  19. 19.
    Bourgoin A, Albanese J, Wereszczynski N, Charbit M, Vialet R, Martin C. Safety of sedation with ketamine in severe head injury patients: comparison with sufentanil. Crit Care Med. 2003;31:711–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Kovarik WD, Mayberg TS, Lam AM, Mathisen TL, Winn HR. Succinylcholine does not change intracranial pressure, cerebral blood flow velocity, or the electroencephalogram in patients with neurologic injury. Anesth Analg. 1994;78:469–73.CrossRefPubMedGoogle Scholar
  21. 21.
    Martyn JA, Richtsfeld M. Succinylcholine-induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms. Anesthesiology. 2006;104:158–69.CrossRefPubMedGoogle Scholar
  22. 22.
    Seder DB, Mayer SA. Critical care management of subarachnoid hemorrhage and ischemic stroke. Clin Chest Med. 2009;30:103–22, viii–ix.Google Scholar
  23. 23.
    Chesnut RM, Marshall SB, Piek J, Blunt BA, Klauber MR, Marshall LF. Early and late systemic hypotension as a frequent and fundamental source of cerebral ischemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir Suppl. 1993;59:121–5.Google Scholar
  24. 24.
    Prough DS, Lang J. Therapy of patients with head injuries: key parameters for management. J Trauma. 1997;42:S10–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Trzeciak S, Jones AE, Kilgannon JH, et al. Significance of arterial hypotension after resuscitation from cardiac arrest. Crit Care Med. 2009;37:2895–903. quiz 904.CrossRefPubMedGoogle Scholar
  26. 26.
    Kilgannon JH, Roberts BW, Reihl LR, et al. Early arterial hypotension is common in the post-cardiac arrest syndrome and associated with increased in-hospital mortality. Resuscitation. 2008;79:410–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Dumont TM, Visioni AJ, Rughani AI, Tranmer BI, Crookes B. Inappropriate prehospital ventilation in severe traumatic brain injury increases in-hospital mortality. J Neurotrauma. 2010;27:1233–41.CrossRefPubMedGoogle Scholar
  28. 28.
    Davis DP, Idris AH, Sise MJ, et al. Early ventilation and outcome in patients with moderate to severe traumatic brain injury. Crit Care Med. 2006;34:1202–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Davis DP, Stern J, Sise MJ, Hoyt DB. A follow-up analysis of factors associated with head-injury mortality after paramedic rapid sequence intubation. J Trauma. 2005;59:486–90.CrossRefPubMedGoogle Scholar
  30. 30.
    Coles JP, Fryer TD, Coleman MR, et al. Hyperventilation following head injury: effect on ischemic burden and cerebral oxidative metabolism. Crit Care Med. 2007;35:568–78.CrossRefPubMedGoogle Scholar
  31. 31.
    Coles JP, Minhas PS, Fryer TD, et al. Effect of hyperventilation on cerebral blood flow in traumatic head injury: clinical relevance and monitoring correlates. Crit Care Med. 2002;30:1950–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Diringer MN, Videen TO, Yundt K, et al. Regional cerebrovascular and metabolic effects of hyperventilation after severe traumatic brain injury. J Neurosurg. 2002;96:103–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Walsh BK, Crotwell DN, Restrepo RD. Capnography/Capnometry during mechanical ventilation: 2011. Respir Care. 2011;56:503–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Seneviratne J, Mandrekar J, Wijdicks EF, Rabinstein AA. Noninvasive ventilation in myasthenic crisis. Arch Neurol. 2008;65:54–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Flandreau G, Bourdin G, Leray V, et al. Management and long-term outcome of patients with chronic neuromuscular disease admitted to the intensive care unit for acute respiratory failure: a single-center retrospective study. Respir Care. 2011;56:953–60.CrossRefPubMedGoogle Scholar
  36. 36.
    Piastra M, Antonelli M, Caresta E, Chiaretti A, Polidori G, Conti G. Noninvasive ventilation in childhood acute neuromuscular respiratory failure: a pilot study. Respiration. 2006;73:791–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Abel M, Eisenkraft JB. Anesthetic implications of myasthenia gravis. Mt Sinai J Med. 2002;69:31–7.PubMedGoogle Scholar
  38. 38.
    Rice MJ, Mancuso AA, Gibbs C, Morey TE, Gravenstein N, Deitte LA. Cricoid pressure results in compression of the postcricoid hypopharynx: the esophageal position is irrelevant. Anesth Analg. 2009;109:1546–52.CrossRefPubMedGoogle Scholar
  39. 39.
    Ellis DY, Harris T, Zideman D. Cricoid pressure in emergency department rapid sequence tracheal intubations: a risk-benefit analysis. Ann Emerg Med. 2007;50:653–65.CrossRefPubMedGoogle Scholar
  40. 40.
    Grande CM, Barton CR, Stene JK. Appropriate techniques for airway management of emergency patients with suspected spinal cord injury. Anesth Analg. 1988;67:714–5.CrossRefPubMedGoogle Scholar
  41. 41.
    Koenig MA, Bryan M, Lewin JL 3rd, Mirski MA, Geocadin RG, Stevens RD. Reversal of transtentorial herniation with hypertonic saline. Neurology. 2008;70:1023–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Qureshi AI, Geocadin RG, Suarez JI, Ulatowski JA. Long-term outcome after medical reversal of transtentorial herniation in patients with supratentorial mass lesions. Crit Care Med. 2000;28:1556–64.CrossRefPubMedGoogle Scholar
  43. 43.
    Oertel M, Kelly DF, Lee JH, et al. Efficacy of hyperventilation, blood pressure elevation, and metabolic suppression therapy in controlling intracranial pressure after head injury. J Neurosurg. 2002;97:1045–53.CrossRefPubMedGoogle Scholar
  44. 44.
    Badjatia N, Strongilis E, Prescutti M, et al. Metabolic benefits of surface counter warming during therapeutic temperature modulation. Crit Care Med. 2009;37:1893–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Wood EG, Go-Wingkun J, Luisiri A, Aceto T Jr. Symptomatic cerebral swelling complicating diabetic ketoacidosis documented by intraventricular pressure monitoring: survival without neurologic sequela. Pediatr Emerg Care. 1990;6:285–8.CrossRefPubMedGoogle Scholar
  46. 46.
    Balan IS, Fiskum G, Hazelton J, Cotto-Cumba C, Rosenthal RE. Oximetry-guided reoxygenation improves neurological outcome after experimental cardiac arrest. Stroke. 2006;37:3008–13.CrossRefPubMedGoogle Scholar
  47. 47.
    Brucken A, Kaab AB, Kottmann K, et al. Reducing the duration of 100 % oxygen ventilation in the early reperfusion period after cardiopulmonary resuscitation decreases striatal brain damage. Resuscitation. 2010;81:1698–703.CrossRefPubMedGoogle Scholar
  48. 48.
    Davis DP, Meade W, Sise MJ, et al. Both hypoxemia and extreme hyperoxemia may be detrimental in patients with severe traumatic brain injury. J Neurotrauma. 2009;26:2217–23.CrossRefPubMedGoogle Scholar
  49. 49.
    Kilgannon JH, Jones AE, Shapiro NI, et al. Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA. 2010;303:2165–71.CrossRefPubMedGoogle Scholar
  50. 50.
    Kilgannon JH, Jones AE, Parrillo JE, et al. Relationship between supranormal oxygen tension and outcome after resuscitation from cardiac arrest. Circulation. 2011;123:2717–22.CrossRefPubMedGoogle Scholar
  51. 51.
    Bellomo R, Bailey M, Eastwood GM, et al. Arterial hyperoxia and in-hospital mortality after resuscitation from cardiac arrest. Crit Care. 2011;15:R90.CrossRefPubMedGoogle Scholar
  52. 52.
    Peberdy MA, Callaway CW, Neumar RW, et al. Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:S768–86.CrossRefPubMedGoogle Scholar
  53. 53.
    Menchem CC. Pulse Oximetry. In: Basow DS, editor. UpToDate. Waltham, MA: UpToDate Publishing; 2012.Google Scholar
  54. 54.
    Helm M, Schuster R, Hauke J, Lampl L. Tight control of prehospital ventilation by capnography in major trauma victims. Br J Anaesth. 2003;90:327–32.CrossRefPubMedGoogle Scholar
  55. 55.
    Hardman JG, Aitkenhead AR. Estimating alveolar dead space from the arterial to end-tidal CO(2) gradient: a modeling analysis. Anesth Analg. 2003;97:1846–51.CrossRefPubMedGoogle Scholar
  56. 56.
    Artigas A, Bernard GR, Carlet J, et al. The American-European Consensus Conference on ARDS, part 2: ventilatory, pharmacologic, supportive therapy, study design strategies, and issues related to recovery and remodeling. Acute respiratory distress syndrome. Am J Respir Crit Care Med. 1998;157:1332–47.PubMedGoogle Scholar
  57. 57.
    Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342:1301–8.Google Scholar
  58. 58.
    Petridis AK, Doukas A, Kienke S, et al. The effect of lung-protective permissive hypercapnia in intracerebral pressure in patients with subarachnoid haemorrhage and ARDS. A retrospective study. Acta Neurochir. 2010;152:2143–5.CrossRefGoogle Scholar
  59. 59.
    Bennett SS, Graffagnino C, Borel CO, James ML. Use of high frequency oscillatory ventilation (HFOV) in neurocritical care patients. Neurocrit Care. 2007;7:221–6.CrossRefPubMedGoogle Scholar
  60. 60.
    Reinprecht A, Greher M, Wolfsberger S, Dietrich W, Illievich UM, Gruber A. Prone position in subarachnoid hemorrhage patients with acute respiratory distress syndrome: effects on cerebral tissue oxygenation and intracranial pressure. Crit Care Med. 2003;31:1831–8.CrossRefPubMedGoogle Scholar
  61. 61.
    Caricato A, Conti G, Della Corte F, et al. Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: the role of respiratory system compliance. J Trauma. 2005;58:571–6.CrossRefPubMedGoogle Scholar
  62. 62.
    Muench E, Bauhuf C, Roth H, et al. Effects of positive end-expiratory pressure on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation. Crit Care Med. 2005;33:2367–72.CrossRefPubMedGoogle Scholar
  63. 63.
    Koutsoukou A, Perraki H, Raftopoulou A, et al. Respiratory mechanics in brain-damaged patients. Intensive Care Med. 2006;32:1947–54.CrossRefPubMedGoogle Scholar
  64. 64.
    Samaniego EA, Mlynash M, Caulfield AF, Eyngorn I, Wijman CA. Sedation confounds outcome prediction in cardiac arrest survivors treated with hypothermia. Neurocrit Care. 2011;15:113–9.CrossRefPubMedGoogle Scholar
  65. 65.
    Riker RR, Fraser GL. Altering intensive care sedation paradigms to improve patient outcomes. Anesthesiol Clin. 2011;29:663–74.CrossRefPubMedGoogle Scholar
  66. 66.
    Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002;30:119–41.CrossRefPubMedGoogle Scholar
  67. 67.
    Fraser GL, Riker RR, Prato BS, Wilkins ML. The frequency and cost of patient-initiated device removal in the ICU. Pharmacotherapy. 2001;21:1–6.CrossRefPubMedGoogle Scholar
  68. 68.
    Skoglund K, Enblad P, Marklund N. Effects of the neurological wake-up test on intracranial pressure and cerebral perfusion pressure in brain-injured patients. Neurocrit Care. 2009;11:135–42.CrossRefPubMedGoogle Scholar
  69. 69.
    Brain Trauma F, American Association of Neurological S, Congress of Neurological S, et al. Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma. 2007;24(Suppl 1):S37–44.Google Scholar
  70. 70.
    Citerio G, Cormio M. Sedation in neurointensive care: advances in understanding and practice. Curr Opin Crit Care. 2003;9:120–6.CrossRefPubMedGoogle Scholar
  71. 71.
    Brook AD, Ahrens TS, Schaiff R, et al. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med. 1999;27:2609–15.CrossRefPubMedGoogle Scholar
  72. 72.
    Kress JP, Pohlman AS, O’Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342:1471–7.CrossRefPubMedGoogle Scholar
  73. 73.
    Mehta S, Burry L, Martinez-Motta JC, et al. A randomized trial of daily awakening in critically ill patients managed with a sedation protocol: a pilot trial. Crit Care Med. 2008;36:2092–9.CrossRefPubMedGoogle Scholar
  74. 74.
    Treggiari MM, Romand JA, Yanez ND, et al. Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med. 2009;37:2527–34.CrossRefPubMedGoogle Scholar
  75. 75.
    Jones C, Backman C, Capuzzo M, Flaatten H, Rylander C, Griffiths RD. Precipitants of post-traumatic stress disorder following intensive care: a hypothesis generating study of diversity in care. Intensive Care Med. 2007;33:978–85.CrossRefPubMedGoogle Scholar
  76. 76.
    Hopkins RO, Jackson JC. Long-term neurocognitive function after critical illness. Chest. 2006;130:869–78.CrossRefPubMedGoogle Scholar
  77. 77.
    Strom T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet. 2010;375:475–80.CrossRefPubMedGoogle Scholar
  78. 78.
    Spies C, Macguill M, Heymann A, et al. A prospective, randomized, double-blind, multicenter study comparing remifentanil with fentanyl in mechanically ventilated patients. Intensive Care Med. 2011;37:469–76.CrossRefPubMedGoogle Scholar
  79. 79.
    Al MJ, Hakkaart L, Tan SS, Bakker J. Cost-consequence analysis of remifentanil-based analgo-sedation vs. conventional analgesia and sedation for patients on mechanical ventilation in the Netherlands. Crit Care. 2010;14:R195.CrossRefPubMedGoogle Scholar
  80. 80.
    Khalifezadeh A, Safazadeh S, Mehrabi T, Mansour BA. Reviewing the effect of nursing interventions on delirious patients admitted to intensive care unit of neurosurgery ward in Al-Zahra Hospital, Isfahan University of Medical Sciences. Iran J Nurs Midwifery Res. 2011;16:106–12.PubMedGoogle Scholar
  81. 81.
    Kline AE, Hoffman AN, Cheng JP, Zafonte RD, Massucci JL. Chronic administration of antipsychotics impede behavioral recovery after experimental traumatic brain injury. Neurosci Lett. 2008;448:263–7.CrossRefPubMedGoogle Scholar
  82. 82.
    Hoffman AN, Cheng JP, Zafonte RD, Kline AE. Administration of haloperidol and risperidone after neurobehavioral testing hinders the recovery of traumatic brain injury-induced deficits. Life Sci. 2008;83:602–7.CrossRefPubMedGoogle Scholar
  83. 83.
    Kline AE, Massucci JL, Zafonte RD, Dixon CE, DeFeo JR, Rogers EH. Differential effects of single versus multiple administrations of haloperidol and risperidone on functional outcome after experimental brain trauma. Crit Care Med. 2007;35:919–24.CrossRefPubMedGoogle Scholar
  84. 84.
    Teitelbaum JS, Ayoub O, Skrobik Y. A critical appraisal of sedation, analgesia and delirium in neurocritical care. Can J Neurol Sci. 2011;38:815–25.PubMedGoogle Scholar
  85. 85.
    Herregods L, Verbeke J, Rolly G, Colardyn F. Effect of propofol on elevated intracranial pressure. Preliminary results. Anaesthesia. 1988;43:107–9.CrossRefPubMedGoogle Scholar
  86. 86.
    Kelly DF, Goodale DB, Williams J, et al. Propofol in the treatment of moderate and severe head injury: a randomized, prospective double-blinded pilot trial. J Neurosurg. 1999;90:1042–52.CrossRefPubMedGoogle Scholar
  87. 87.
    Herregods L, Mergaert C, Rolly G, Collardyn F. Comparison of the effects of 24-hour propofol or fentanyl infusions on intracranial pressure. J Drug Dev. 1989;2:99–100.Google Scholar
  88. 88.
    Cremer OL, Moons KG, Bouman EA, Kruijswijk JE, de Smet AM, Kalkman CJ. Long-term propofol infusion and cardiac failure in adult head-injured patients. Lancet. 2001;357:117–8.CrossRefPubMedGoogle Scholar
  89. 89.
    Iyer VN, Hoel R, Rabinstein AA. Propofol infusion syndrome in patients with refractory status epilepticus: an 11-year clinical experience. Crit Care Med. 2009;37:3024–30.CrossRefPubMedGoogle Scholar
  90. 90.
    Barrientos-Vega R, Mar Sanchez-Soria M, Morales-Garcia C, Robas-Gomez A, Cuena-Boy R, Ayensa-Rincon A. Prolonged sedation of critically ill patients with midazolam or propofol: impact on weaning and costs. Crit Care Med. 1997;25:33–40.CrossRefPubMedGoogle Scholar
  91. 91.
    Jakob SM, Ruokonen E, Grounds RM, et al. Dexmedetomidine vs. midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA. 2012;307:1151–60.CrossRefPubMedGoogle Scholar
  92. 92.
    Yahwak JA, Riker RR, Fraser GL, Subak-Sharpe S. Determination of a lorazepam dose threshold for using the osmol gap to monitor for propylene glycol toxicity. Pharmacotherapy. 2008;28:984–91.CrossRefPubMedGoogle Scholar
  93. 93.
    Horinek EL, Kiser TH, Fish DN, MacLaren R. Propylene glycol accumulation in critically ill patients receiving continuous intravenous lorazepam infusions. Ann Pharmacother. 2009;43:1964–71.CrossRefPubMedGoogle Scholar
  94. 94.
    Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009;301:489–99.CrossRefPubMedGoogle Scholar
  95. 95.
    Mirski MA, Lewin JJ 3rd, Ledroux S, et al. Cognitive improvement during continuous sedation in critically ill, awake and responsive patients: the Acute Neurological ICU Sedation Trial (ANIST). Intensive Care Med. 2010;36:1505–13.CrossRefPubMedGoogle Scholar
  96. 96.
    Tang JF, Chen PL, Tang EJ, May TA, Stiver SI. Dexmedetomidine controls agitation and facilitates reliable, serial neurological examinations in a non-intubated patient with traumatic brain injury. Neurocrit Care. 2011;15:175–81.CrossRefPubMedGoogle Scholar
  97. 97.
    Grof TM, Bledsoe KA. Evaluating the use of dexmedetomidine in neurocritical care patients. Neurocrit Care. 2010;12:356–61.CrossRefPubMedGoogle Scholar
  98. 98.
    Chen HI, Malhotra NR, Oddo M, Heuer GG, Levine JM, LeRoux PD. Barbiturate infusion for intractable intracranial hypertension and its effect on brain oxygenation. Neurosurgery. 2008;63:880–6. discussion 6–7.CrossRefPubMedGoogle Scholar
  99. 99.
    Marshall GT, James RF, Landman MP, et al. Pentobarbital coma for refractory intra-cranial hypertension after severe traumatic brain injury: mortality predictions and one-year outcomes in 55 patients. J Trauma. 2010;69:275–83.CrossRefPubMedGoogle Scholar
  100. 100.
    Claassen J, Hirsch LJ, Mayer SA. Treatment of status epilepticus: a survey of neurologists. J Neurol Sci. 2003;211:37–41.CrossRefPubMedGoogle Scholar
  101. 101.
    Karabinis A, Mandragos K, Stergiopoulos S, et al. Safety and efficacy of analgesia-based sedation with remifentanil versus standard hypnotic-based regimens in intensive care unit patients with brain injuries: a randomised, controlled trial [ISRCTN50308308]. Crit Care. 2004;8:R268–80.CrossRefPubMedGoogle Scholar
  102. 102.
    Riker RR, Picard JT, Fraser GL. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med. 1999;27:1325–9.CrossRefPubMedGoogle Scholar
  103. 103.
    Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166:1338–44.CrossRefPubMedGoogle Scholar
  104. 104.
    Deogaonkar A, Gupta R, DeGeorgia M, et al. Bispectral Index monitoring correlates with sedation scales in brain-injured patients. Crit Care Med. 2004;32:2403–6.CrossRefPubMedGoogle Scholar
  105. 105.
    Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27:859–64.CrossRefPubMedGoogle Scholar
  106. 106.
    Van Rompaey B, Elseviers MM, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Bossaert L. Risk factors for delirium in intensive care patients: a prospective cohort study. Crit Care. 2009;13:R77.CrossRefPubMedGoogle Scholar
  107. 107.
    Frontera JA. Delirium and sedation in the ICU. Neurocrit Care. 2011;14:463–74.CrossRefPubMedGoogle Scholar
  108. 108.
    McDonagh DL, Olson DM, Kalia JS, Gupta R, Abou-Chebl A, Zaidat OO. Anesthesia and sedation practices among neurointerventionalists during acute ischemic stroke endovascular therapy. Front Neurol. 2010;1:118.PubMedGoogle Scholar
  109. 109.
    Abou-Chebl A, Lin R, Hussain MS, et al. Conscious sedation versus general anesthesia during endovascular therapy for acute anterior circulation stroke: preliminary results from a retrospective, multicenter study. Stroke. 2010;41:1175–9.CrossRefPubMedGoogle Scholar
  110. 110.
    Jumaa MA, Zhang F, Ruiz-Ares G, et al. Comparison of safety and clinical and radiographic outcomes in endovascular acute stroke therapy for proximal middle cerebral artery occlusion with intubation and general anesthesia versus the nonintubated state. Stroke. 2010;41:1180–4.CrossRefPubMedGoogle Scholar
  111. 111.
    Olson DM, Thoyre SM, Peterson ED, Graffagnino C. A randomized evaluation of bispectral index-augmented sedation assessment in neurological patients. Neurocrit Care. 2009;11:20–7.CrossRefPubMedGoogle Scholar
  112. 112.
    Enblad P, Nilsson P, Chambers I, et al. R3-survey of traumatic brain injury management in European Brain IT centres year 2001. Intensive Care Med. 2004;30:1058–65.CrossRefPubMedGoogle Scholar

Copyright information

© Neurocritical Care Society 2012

Authors and Affiliations

  • David B. Seder
    • 1
  • Richard R. Riker
    • 1
  • Andy Jagoda
    • 2
  • Wade S. Smith
    • 3
  • Scott D. Weingart
    • 4
  1. 1.Department of Critical Care Services, Maine Medical CenterTufts University School of MedicineBostonUSA
  2. 2.Department of Emergency MedicineMount Sinai Medical CenterNew YorkUSA
  3. 3.ENLS Course Co-Chair, Department of NeurologyUniversity of California, San FranciscoSan FranciscoUSA
  4. 4.ENLS Course Co-Chair, Division of ED Critical CareMount Sinai School of MedicineNew York USA

Personalised recommendations