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Purpose <p>To investigate the association between dynamic driving pressure (Δ<i>Pdyn</i>) and mortality in mechanically ventilated patients with acute brain injury (ABI), and to evaluate whether neurological and pulmonary injury severity modify this relationship.</p> Methods <p>This prespecified secondary analysis of the VENTIBRAIN prospective study (NCT04459884) included mechanically ventilated adult patients with ABI (traumatic brain injury, subarachnoid hemorrhage, intracranial hemorrhage, or ischemic stroke). Δ<i>Pdyn</i> was calculated daily over the first 14 days as peak inspiratory pressure minus positive end-expiratory pressure (PEEP). Bayesian joint models evaluated the time-varying association between Δ<i>Pdyn</i> and mortality at ICU discharge, hospital discharge, and 6&#xa0;months. Secondary analyses evaluated effect modification by baseline Glasgow Coma Scale (GCS), PaO₂/FiO₂, and ABI subtype.</p> Results <p>Among 1,555 patients (median age 59 years, 34.5% female), higher time-varying Δ<i>Pdyn</i> was associated with increased ICU mortality (hazard ratio [HR], 1.057 per daily 1cmH<sub>2</sub>O; 95% credible interval, 1.037–1.078; posterior probability of HR &gt; 1, 99.9%). Findings were consistent across all ABI subtypes and were similar for static Δ<i>P</i> (plateau pressure minus PEEP). The association was strongest in patients with severe ABI (GCS ≤ 8) and severe hypoxemia (PaO₂/FiO₂ ≤ 100). Results were robust across all outcome timepoints and multiple sensitivity analyses.</p> Conclusion <p>Higher time-varying Δ<i>Pdyn</i> was associated with increased mortality in this cohort of patients with ABI. Neurological injury severity independently modified the harm from Δ<i>Pdyn</i> with a magnitude comparable to severe hypoxemia. Measurement of Δ<i>Pdyn</i> may aid risk stratification and ventilation strategies in ABI; future trials should evaluate the effect of reducing Δ<i>Pdyn</i> in this population.</p>

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Dynamic driving pressure and clinical outcomes in mechanically ventilated patients with acute brain injury: a secondary analysis of the VENTIBRAIN study*

  • 期刊论文

  • 发表日期：

    2026年1月15日

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  • Shaurya Taran,
  • Giuseppe Citerio,
  • Fabio S. Taccone,
  • Emanuele Rezoagli,
  • Kuan Liu,
  • Victoria A. McCredie,
  • John G. Laffey,
  • Lorenzo Calabro,
  • Nicolo A. Patroniti,
  • Francesca Graziano,
  • Paola Rebora,
  • Chiara Robba,
  • Neill K. J. Adhikari,
  • 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,
  • Sarah Wahlster,
  • Christian Putensen,
  • 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,
  • Wenjin Chen,
  • Lidan Jiang,
  • Liang Wu,
  • Heng Zhang,
  • Liqing Bi,
  • Jingmei Wang,
  • Yong Li,
  • Ziyue Wang,
  • Guang Feng,
  • Yangong Chao,
  • Giulia Ciparelli,
  • 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,
  • Antonio Messina,
  • 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,
  • Valentina Chiarini,
  • Silvia Cavagna,
  • Lorenzo Gamberini,
  • Muhammed Elhadi,
  • 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,
  • Piergiorgio Lochner,
  • Michele Beomonte Zobel,
  • Estera Harajdova,
  • Domenico Gelormini,
  • Marilena Casartelli Liviero,
  • Leonardo Gottin,
  • Rafael Badenes,
  • 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

To investigate the association between dynamic driving pressure (ΔPdyn) and mortality in mechanically ventilated patients with acute brain injury (ABI), and to evaluate whether neurological and pulmonary injury severity modify this relationship.

Methods

This prespecified secondary analysis of the VENTIBRAIN prospective study (NCT04459884) included mechanically ventilated adult patients with ABI (traumatic brain injury, subarachnoid hemorrhage, intracranial hemorrhage, or ischemic stroke). ΔPdyn was calculated daily over the first 14 days as peak inspiratory pressure minus positive end-expiratory pressure (PEEP). Bayesian joint models evaluated the time-varying association between ΔPdyn and mortality at ICU discharge, hospital discharge, and 6 months. Secondary analyses evaluated effect modification by baseline Glasgow Coma Scale (GCS), PaO₂/FiO₂, and ABI subtype.

Results

Among 1,555 patients (median age 59 years, 34.5% female), higher time-varying ΔPdyn was associated with increased ICU mortality (hazard ratio [HR], 1.057 per daily 1cmH2O; 95% credible interval, 1.037–1.078; posterior probability of HR > 1, 99.9%). Findings were consistent across all ABI subtypes and were similar for static ΔP (plateau pressure minus PEEP). The association was strongest in patients with severe ABI (GCS ≤ 8) and severe hypoxemia (PaO₂/FiO₂ ≤ 100). Results were robust across all outcome timepoints and multiple sensitivity analyses.

Conclusion

Higher time-varying ΔPdyn was associated with increased mortality in this cohort of patients with ABI. Neurological injury severity independently modified the harm from ΔPdyn with a magnitude comparable to severe hypoxemia. Measurement of ΔPdyn may aid risk stratification and ventilation strategies in ABI; future trials should evaluate the effect of reducing ΔPdyn in this population.