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Purpose <p>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.</p> Methods <p>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.</p> Results <p>On admission, 2095 recruited patients (median age 58 [interquartile range 45–70] years, 66.1% male) had a median plateau pressure (Pplat) of 15 (13–18) cmH<sub>2</sub>0, tidal volume/predicted body weight 6.5 (5.7–7.3) mL/Kg, driving pressure 9 (7–12) cmH<sub>2</sub>0, and positive end-expiratory pressure 5 (5–8) cmH<sub>2</sub>0, with no modifications in case of increased intracranial pressure (&gt; 20&#xa0;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.</p> Conclusions <p>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.</p>

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Ventilation practices in acute brain injured patients and association with outcomes: the VENTIBRAIN multicenter observational study

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  • 发表日期：

    2025年2月24日

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  • Chiara Robba,
  • Daniele Giardiello,
  • Chiara Almondo,
  • Karim Asehnoune,
  • Rafael Badenes,
  • Raphael 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,
  • 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,
  • Arturo Chieregato,
  • Federico Pozzi,
  • Cristiana Cipolla,
  • Anna Bortolaso,
  • Linda Bosa,
  • Antonella Cotoia,
  • Tecla Zimotti,
  • Filippo Di Pierro,
  • Davide Correnti,
  • Luciano Napolitano,
  • Giuseppe Ferrara,
  • Abele Donati,
  • Vincenzo Gabbanelli,
  • Lucia Pesaresi,
  • Giulia Mariotti,
  • Evdokia Gavrielatou,
  • Konstantinos Gkirgkiris,
  • Vasileios Grigoropoulos,
  • Ilias Siempos,
  • Anna Lindner,
  • Verena Rass,
  • Philipp Kindl,
  • Lauma Putnina,
  • Maurizio Cecconi,
  • Federico Villa,
  • Daniele Bono,
  • Andrea Cortegiani,
  • Giulia Ingoglia,
  • Santi Maurizio Raineri,
  • Mariachiara Ippolito,
  • Feng Wei,
  • Ao Jiao,
  • Sami Sannoufa,
  • Mhd Noor Tahawi,
  • Mohammad Eyad Takahji,
  • Chiarini Valentina,
  • Cavagna Silvia,
  • Gamberini Lorenzo,
  • Joana Ferreira,
  • Dário Batista,
  • Yannick Hourmant,
  • Antoine Roquilly,
  • Raphaël Cinotti,
  • Katharina Krenn,
  • Alessia Felli,
  • Petra Hobart,
  • Essam Eldien Abuobaida Banaga Haj Eltayeb,
  • Hayat Abuobaida Bannaga,
  • Ubay Abdullah Kareem Allah Alday,
  • Lochner Piergiorgio,
  • Beomonte Zobel Michele,
  • Harajdova Estera,
  • Domenico Gelormini,
  • Marilena Casartelli Liviero,
  • Leonardo Gottin,
  • Berta Monleón,
  • Nekane Romero-García,
  • Hussam Elmelliti,
  • Phool Iqbal,
  • Foziya Solanki,
  • Ahmed Lutfe Abdussalam,
  • Amr Elwany,
  • Mohamed Shemeis,
  • AbdulRhman Alaa,
  • Reem Hunain,
  • Shwethapriya Rao,
  • Zehra Siddiqui,
  • Juan Olivella-Gomez,
  • Emilio Viñán-Garcés,
  • Anselmo Caricato,
  • Luca Pisapia,
  • Camilla Gelormini,
  • Pouya Tahsili-Fahadan,
  • Jing Wang,
  • Naveen M. Altaweel,
  • Fabio Micheli,
  • Paolo Gritti,
  • Clotilde Schilte,
  • Gilles Francony,
  • Vera Spatenkova,
  • Ondrej Brandejs,
  • Hang Chen,
  • Minli Chen,
  • Guang Feng,
  • Yanru Li,
  • Reng Ren,
  • Carlos Ferrando,
  • Luigi Zattera,
  • Claudia de Peray,
  • Anna Recasens,
  • Mohamed Elbahnasawy,
  • Mohamed Nasreddin,
  • Mohamed Shama,
  • Min Zhou,
  • Rui Tang,
  • Nitin Manohara,
  • Mukilan Balasubramanian,
  • Isaac Babu,
  • Ciara Hanley,
  • Ciprian Nita,
  • Reem Elsaadany,
  • Wen Wu,
  • Yman Majdi Ibrahim Mohammed,
  • Saifaleslam Elsahli,
  • Aiman Al-Touny,
  • Mohammed Alsharif,
  • Andreja Möller Petrun,
  • Gemma Gomà,
  • Manuel J. Rivera-Chávez,
  • Sung-Min Cho,
  • Matthew Bower,
  • Jose I. Suarez,
  • Jinfang Liu,
  • Maytham A. Al-juaifari,
  • Dietrich Henzler,
  • Almu’atasim Khamees,
  • Tania Huanca Felipez,
  • Bourhan Mohammad Hassan Alrayes,
  • Shuhan Cai,
  • Daniel Godoy

摘要

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

On admission, 2095 recruited patients (median age 58 [interquartile range 45–70] years, 66.1% male) had a median plateau pressure (Pplat) of 15 (13–18) cmH20, tidal volume/predicted body weight 6.5 (5.7–7.3) mL/Kg, driving pressure 9 (7–12) cmH20, and positive end-expiratory pressure 5 (5–8) cmH20, 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.