Ventilation practices in acute brain injured patients and association with outcomes: the VENTIBRAIN multicenter observational study
Chiara Robba, Daniele Giardiello, Chiara Almondo, Karim Asehnoune, Rafael Badenes, Raphaël Cinotti, Muhammed Elhadi, Francesca Graziano, Raimund Helbok, Lidan Jiang, Wenjin Chen, John G. Laffey, Antonio Messina, Christian Putensen, Marcus J. Schultz, Sarah Wahlster, Paola Rebora, Stefania Galimberti, Fabio Silvio Taccone, Giuseppe Citerio, the VENTIBRAIN study group, Chenggong Hu, Tingting Liu, Meiling Dong, Wei Yang, Ying Yang, Yinxia Lv, Hongtao Xia, Bangguo Zhang, Qionglan Dong, Dan Xu, Yunxing Cao, Natalie L. Smith, Nassim S. Matin, Adrienne James, Abhijit V. Lele, James A. Town, Stefan Ehrentraut, Felix Lehmann, Stefan Kreyer, Thomas Muders, Jens Poth, Yvonne Klevenhaus, Andrea Sauer, Christian Bode, Konrad Peukert, Qibing Huang, Zeli Zhang, Shoujia Sun, Min Xu, Kun Yang, Ruifang She, Ben Sang, Liangpeng Song, Lisheng Wu, Liang Wu, Heng Zhang, Liqing Bi, Jingmei Wang, Yong Li, Ziyue Wang, Guang Feng, Yangong Chao, Giulia Ciparelli, Nicoló Patroniti, Nicoló Patroniti, Camilla Paolessi, Carlotta Bandoni, Maura Mandelli, Gianni Ciabatti, Patrick Rusagara, Vanni Orzalesi, Luca Bucciardini, Fabio Picciafuochi, Alessandra De Luca, Elena Torrini, Laura Cosenza, Maria Amigoni, Paolo Mangili, Valentina Piazza, Melisa Juliana Polo Friz, Silvia del Bianco, Margherita Valla, Giorgia Ogliari, Alberto Addis, Jorge H. Mejía-Mantilla, Leidy Gaviria Villarreal, Ángela Marulanda, José Luis Aldana, Luis Figueroa, Leidy Johanna Bolaños, Jackeline Vivas, Diana Marcela Londoño, Vincent Legros, Thierry Floch, Marion Leclercq-Rouget, Pierre-Antoine Seube-Remy, Lison Menage-Innocenti, Cindy Chauchard, Francesca Fossi
Abstract
PURPOSE: Current mechanical ventilation practices for patients with acute brain injury (ABI) are poorly defined. This study aimed to describe ventilator settings/parameters used in intensive care units (ICUs) and evaluate their association with clinical outcomes in these patients. METHODS: An international, prospective, multicenter, observational study was conducted across 74 ICUs in 26 countries, including adult patients with ABI (e.g., traumatic brain injury, intracranial hemorrhage, subarachnoid hemorrhage, and acute ischemic stroke), who required ICU admission and invasive mechanical ventilation. Ventilatory settings were recorded daily during the first week and on days 10 and 14. ICU and 6-months mortality and 6-months neurological outcome were evaluated. RESULTS: 0, with no modifications in case of increased intracranial pressure (> 20 mmHg). Significant differences in practices were observed across different countries. The majority of these ventilatory settings were associated with ICU mortality, with the highest hazard ratio (HR) for Pplat (odds ratio 1.50; 95% confidence interval, CI: 1.27-1.78). The results demonstrated consistent association with 6-month mortality; less clear association was observed for neurological outcome. CONCLUSIONS: Protective ventilation strategies are commonly used in ABI patients but with high variability across different countries. Ventilator settings during ICU stay were associated with an increased risk of ICU and 6-month mortality, but not an unfavorable neurological outcome.