Enhancing Cerebral Protection: A Closed-Loop Ventilation Approach (Artificial Intelligence) for Targeted Carbon Dioxide Regulation in Traumatic Brain Injury

Background: Closed-loop ventilators (CLVs): CLVs also known as automated ventilators, are advanced systems that automatically adjust ventilator settings based on the patient’s respiratory mechanics. Unlike open-loop ventilators (OLVs), which require manual parameter adjustments, CLVs use real-time feedback to maintain target oxygen saturation (SpO<sub>2</sub>) and end-tidal carbon dioxide (EtCO<sub>2</sub>) levels, enhancing patient comfort and reducing complications. Cerebral Protection in Traumatic Brain Injury (TBI): Maintaining normoxia, and normocapnia is crucial for cerebral protection in TBI. High carbon dioxide (CO<sub>2</sub>) levels cause vasodilation, increasing intracranial pressure, while low levels cause vasoconstriction, reducing cerebral perfusion. CLVs automatically adjust ventilator settings based on continuous patient feedback, optimizing CO<sub>2</sub> levels and cerebral blood flow (CBF). Case Presentation: A 19-year-old male with severe TBI was intubated and connected to a fully automated CLV and set to "Brain Injury" mode. The ventilator automatically adjusted parameters to achieve target end-tidal carbon dioxide (EtCO<sub>2</sub>) levels, evidenced by subsequent arterial blood gas (ABG) results showing desired partial pressure of carbon dioxide (pCO<sub>2</sub>) and partial pressure of oxygen (pO<sub>2</sub>) levels. Conclusion: CLVs in TBI patients automatically manage CO<sub>2</sub> elimination and oxygen delivery using simplified settings, adjusting based on real-time oxygen saturation (SpO<sub>2</sub>) and EtCO<sub>2</sub> levels. This approach maintains normocapnia and normoxia, meeting cerebral protection criteria with fewer manual adjustments, advantageous in the emergency department (ED). CLVs offer a practical solution in the ED, automating ventilator adjustments to maintain desired CO<sub>2</sub> levels, thus shifting the clinician's role from manual “presetting” to “deciding” target CO<sub>2</sub> levels. This automation improves efficiency and patient outcomes in a hectic clinical environment.