Recommendations for invasive ventilatory management with ischemic stroke and COVID-19

Abstract

Introduction: The main guidelines for the treatment of ischemic stroke in the course of COVID-19 infection do not offer suggestions on the use of artificial mechanical ventilation in these patients.

Objective: Describe elements of interest on the use of artificial mechanical ventilation in patients with ischemic stroke and COVID-19.

Method: Narrative review of the literature available in English and Spanish in databases such as: PubMed, SciELO and Google scholar. The descriptors "COVID-19", "SARS-CoV-2", "neurological manifestations", "acute ischemic stroke", "acute brain injury", "mechanical ventilation", "respiratory failure", "ARDS", "neurocritical care", among others, were used. Given the scarce published evidence, the criteria presented were carried out on the basis of what was reported for patients with ischemic stroke and mechanical ventilation without COVID-19.

Results: Ischemic stroke in the course of COVID-19 infection has a high mortality rate. It occurs mainly in the most severe stage of the disease, mostly in patients with acute respiratory distress syndrome. The use of mechanical ventilation can be controversial because of its effect on the brain.

Conclusions: To date there are no publications on ventilatory management in this particular case. Based on what has been documented in ventilated patients with ischemic stroke or acute brain damage, protective ventilation can be used safely, as well as the use of prone position maneuvers, always under strict monitoring of intracranial pressure.

Keywords: COVID-19; ischemic stroke; artificial mechanical ventilation; ARDS.