{"id":752,"date":"2025-03-15T06:00:47","date_gmt":"2025-03-15T06:00:47","guid":{"rendered":"https:\/\/perfusfind.com\/ic\/?p=752"},"modified":"2025-03-15T01:31:35","modified_gmt":"2025-03-15T01:31:35","slug":"ventilation-practices-in-acute-brain-injured-patients-and-association-with-outcomes-the-ventibrain-multicenter-observational-study","status":"publish","type":"post","link":"https:\/\/perfusfind.com\/ic\/index.php\/2025\/03\/15\/ventilation-practices-in-acute-brain-injured-patients-and-association-with-outcomes-the-ventibrain-multicenter-observational-study\/","title":{"rendered":"Ventilation practices in acute brain injured patients and association with outcomes: the VENTIBRAIN multicenter observational study"},"content":{"rendered":"

Summary of “Ventilation Practices in Acute Brain Injured Patients and Association with Outcomes: The VENTIBRAIN Multicenter Observational Study”<\/h3>\n
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Abstract<\/h3>\n

The optimal ventilation strategies for patients with acute brain injury (ABI) remain uncertain, given the potential conflicts between lung-protective ventilation and the need to maintain cerebral perfusion. This international, multicenter observational study analyzed ventilatory settings in 2,095 ICU patients with ABI, including traumatic brain injury, intracranial hemorrhage, subarachnoid hemorrhage, and acute ischemic stroke. Lung-protective ventilation (LPV) was frequently used, though variability in ventilator settings was observed across countries. Higher plateau pressure (Pplat), driving pressure, and peak inspiratory pressure were associated with increased ICU and 6-month mortality, while no clear link was established between ventilatory settings and long-term neurological outcomes.<\/p>\n

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Caterpillar plots of between-country variability for every ventilator setting parameter. Estimated random effects of every country (blue dots) with the corresponding 95% confidence intervals (black lines) from a linear mixed-effects model using individuals and countries as random intercepts and adjusted for age (per decade), sex, time of ventilator parameter collection during the ICU stay (from day 0\/day 1 and daily till day 7 and day 10 and day 14), type of brain injury, Glasgow coma motor score, PaO2\/FiO2 ratio at admission, and pupillary reactivity as fixed-effects. Random effects point and interval estimates close to zero represent countries with a ventilator parameter\/setting close to the overall mean. Random effects and interval estimates below or above zero represent countries with a lower or higher ventilator measure set below or above the overall mean, respectively. The intraclass correlation coefficients (ICCs) and the variance partition coefficients (VPCs) are also reported. Higher values of ICCs and VPCs (closer to one) suggest a higher country-level contextual effect. Panel A<\/strong> plateau pressure, panel B<\/strong> driving pressure, panel C<\/strong> tidal volume per body weight, panel D<\/strong> positive and expiratory pressure (PEEP), panel E<\/strong>: respiratory rate, panel F<\/strong> FiO2<\/figcaption><\/figure>\n

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Key Points<\/h3>\n
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    High Utilization of Lung-Protective Ventilation:<\/strong> 86.1% of patients received LPV, characterized by a median tidal volume of 6.5 mL\/kg predicted body weight (PBW) and PEEP of 5 cmH\u2082O.<\/p>\n<\/li>\n

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    Significant Variability in Ventilatory Practices:<\/strong> Differences in tidal volumes, PEEP, driving pressure, and mechanical power were observed between participating countries.<\/p>\n<\/li>\n

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    Association of Plateau and Driving Pressure with Mortality:<\/strong> Higher Pplat (\u226515 cmH\u2082O) and driving pressure (>9 cmH\u2082O) correlated with increased ICU and 6-month mortality rates.<\/p>\n<\/li>\n

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    Protective Role of Moderate Tidal Volumes:<\/strong> A small but significant reduction in mortality was observed in patients receiving slightly higher tidal volumes (7-8 mL\/kg PBW), challenging the traditional LPV approach.<\/p>\n<\/li>\n

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    Lack of Adjustments for Intracranial Hypertension:<\/strong> Despite concerns about the impact of mechanical ventilation on cerebral hemodynamics, ventilatory settings remained unchanged in patients with elevated intracranial pressure (ICP > 20 mmHg).<\/p>\n<\/li>\n

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    PEEP and FiO\u2082 Showed a U-Shaped Relationship with Mortality:<\/strong> Both excessively low and high values of PEEP and FiO\u2082 were associated with worse ICU outcomes.<\/p>\n<\/li>\n

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    Neurological Outcomes Were Not Strongly Affected by Ventilatory Settings:<\/strong> No significant correlation was found between ventilatory settings and unfavorable 6-month neurological outcomes, as measured by the extended Glasgow Outcome Scale (GOSE).<\/p>\n<\/li>\n

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    Association Between FiO\u2082 and Neurological Recovery:<\/strong> Higher FiO\u2082 levels were linked to worse neurological outcomes, suggesting potential oxygen toxicity or oxidative stress in ABI patients.<\/p>\n<\/li>\n

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    Need for Standardized Guidelines:<\/strong> The study highlights the lack of consensus on optimal ventilatory strategies for ABI patients and calls for the development of standardized international guidelines.<\/p>\n<\/li>\n

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    Future Research Directions:<\/strong> Further randomized controlled trials are needed to assess individualized ventilation strategies that balance lung protection with cerebral perfusion optimization.<\/p>\n<\/li>\n<\/ol>\n

    Conclusion<\/h3>\n

    This study demonstrates the widespread adoption of lung-protective ventilation in ABI patients but highlights significant variability in clinical practice across ICUs. Higher plateau and driving pressures were associated with increased mortality, while a moderate tidal volume strategy appeared beneficial. Despite these findings, ventilatory settings had no clear impact on long-term neurological outcomes. Future research should focus on personalized mechanical ventilation strategies tailored to the complex interplay between lung and brain physiology.<\/p>\n

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    Ventilation practices in acute brain injured patients and association with outcomes: the VENTIBRAIN multicenter observational study<\/figcaption><\/figure>\n
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    Open Access<\/strong> This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Summary of “Ventilation Practices in Acute Brain Injured Patients and Association with Outcomes: The VENTIBRAIN Multicenter Observational Study” Abstract The optimal ventilation strategies for patients with acute brain injury (ABI) remain uncertain, given the potential conflicts between lung-protective ventilation and the need to maintain cerebral perfusion. This international, multicenter observational study analyzed ventilatory settings in […]<\/p>\n","protected":false},"author":1,"featured_media":753,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[6],"tags":[343,384,40,383],"class_list":["post-752","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-mechanical-ventilation","tag-acute-brain-injury","tag-cerebrovascular-disease","tag-mechanical-ventilation","tag-traumatic-brain-injury"],"yoast_head":"\nVentilation practices in acute brain injured patients and association with outcomes: the VENTIBRAIN multicenter observational study - Perfusfind Intensive Care<\/title>\n<meta name=\"description\" content=\"The VENTIBRAIN multicenter observational study investigates mechanical ventilation practices in acute brain injury (ABI) patients across 74 ICUs in 26 countries. 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