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انتوباسیون
Patients with GCS scores of 8 or less should be intubated and ventilated with a tar- get of PaO2 above 80 mm Hg.
Ketamine was contraindicated in TBI patients due to perceived risks of causing intracranial hypertension, but in intubated and ventilated patients, ketamine has no adverse effect on ICP.126 Ketamine has several favorable effects like reduced need of supplementary vasopressors and narcot- ics, activation of bowel movement, and bronchodilation.127 Narcotics, like sufentanil, fentanyl, and remifentanil, have no negative effects on ICP as long as MAP is maintained.
As hypoxia leads to poor outcome after SCI, patients who develop respiratory insuf- ficiency should be intubated as soon as possible.
The patient's airway should be assessed, and tracheal intubation must be considered in stuporous or comatose patients.
Although intubation and mechanical ventilation is associated with poor outcome and increased mortality, prevention of hypoxia and aspiration pneumonia should be considered.198
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