Table 1 Respiratory management of intubated ABI patients with and without intracranial hypertension and/or ARDS

VT [44,45,46]

7–9 ml/kg PBW

7–9 ml/kg PBW

6–8 ml/kg PBW

6–8 ml/kg PBW

PEEP [47, 47,48,49,50]

5 cmH₂O

5 cmH₂O. If higher PEEP, surveillance of ICP/CPP/multimodal brain monitoring

At least 5 cmH₂O, higher PEEP in more severe ARDS, titration based on plateau pressure, driving pressure, oxygenation and hemodynamic response to higher PEEP

At least 5 cmH₂O, higher PEEP in more severe ARDS, titration based on plateau pressure, driving pressure, oxygenation and hemodynamic response to higher PEEP

ICP/CPP/multimodal brain monitoring

PaO₂ target (mmHg) [25, 26, 51]

Avoid hyperoxemia (PaO₂ > 200)

PaO₂ 80–200

PaO₂ 80–120, depending of ARDS severity

PaO₂ 80–200

PaCO₂ target (mmHg) [38]

PaCO₂ 35–45

PaCO₂ 32–38

Permissive hypercapnia (< 60), depending on pH (> 7, 25)

Permissive hypercapnia contraindicated. Adjunctive therapy earlier

ICP/CPP/multimodal brain monitoring

Prone position [52]

Not recommended

Not recommended

PaO₂/FIO₂ < 150 mmHg with PEEP ≥ 5 cmH₂O

PaO₂/FIO₂ < 150 mmHg

Case-by-case basis

ICP/CPP/multimodal brain monitoring

Lung recruitment [53]

Systematic use, not recommended

Systematic use, not recommended

Systematic use, not recommended

Systematic use, not recommended

Fluid restriction strategy [54, 55]

Not recommended unless specific indication

Avoid positive fluid balance and target euvolemia for CPP management

Avoid hypotonic fluids

Yes

Avoid positive fluid balance and target euvolemia for CPP management

Avoid hypotonic fluids

ICP/CPP/multimodal brain monitoring

Steroids [56, 57]

No indication except for specific indication

Higher mortality in TBI with high dose of methylprednisolone

Dexamethasone may be indicated

If TBI severity is the main problem steroids may be avoided. Steroids may be beneficial if ARDS is the dominant problem