ABSTRACT
Respiratory management in patients with acute severe brain injury is an important part of the integrated critical management.A series of special pathophysiological changes and clinical manifestations after brain injury make it different from non-central nervous system diseases.Lung protective ventilation strategy and evidence from clinical trials have challenged the traditional view of respiratory management:hypocarbonemia and low PEEP strategy are no longer routine options for respiratory management in patients with brain injury,but respiratory management still needs to follow the principle of "avoiding secondary injury".Multimodal neuromonitoring shows good prospects,which is helpful to achieve the precision of respiratory management by optimizing the targets of the management of intracranial pressure,cerebral perfusion and cerebral oxygen metabolism.