Multicentre observational study on practice of ventilation in brain injured patients: the VENTIBRAIN study protocol

Chiara Robba, Giuseppe Citerio, Fabio S Taccone, Stefania Galimberti, Paola Rebora, Alessia Vargiolu, Paolo Pelosi, VENTIBRAIN Enlarged Steering committee members, VENTIBRAIN, Maura Mandelli, Jordi Mancebo, Robert Stevens, Geert Meyfroidt, Rafael Badenes, Valentina Della Torre, Raimund Helbok, Jose' Suarez, Nino Stocchetti, Marcelo Gama De Abreu, Marcus Schultz, Raphael Cinotti, Louis Blanch, Karim Asehnoune, Christian Putensen, John Laffey, Chiara Robba, Giuseppe Citerio, Fabio S Taccone, Stefania Galimberti, Paola Rebora, Alessia Vargiolu, Paolo Pelosi, VENTIBRAIN Enlarged Steering committee members, VENTIBRAIN, Maura Mandelli, Jordi Mancebo, Robert Stevens, Geert Meyfroidt, Rafael Badenes, Valentina Della Torre, Raimund Helbok, Jose' Suarez, Nino Stocchetti, Marcelo Gama De Abreu, Marcus Schultz, Raphael Cinotti, Louis Blanch, Karim Asehnoune, Christian Putensen, John Laffey

Abstract

Introduction: Mechanical ventilatory is a crucial element of acute brain injured patients' management. The ventilatory goals to ensure lung protection during acute respiratory failure may not be adequate in case of concomitant brain injury. Therefore, there are limited data from which physicians can draw conclusions regarding optimal ventilator management in this setting.

Methods and analysis: This is an international multicentre prospective observational cohort study. The aim of the 'multicentre observational study on practice of ventilation in brain injured patients'-the VENTIBRAIN study-is to describe the current practice of ventilator settings and mechanical ventilation in acute brain injured patients. Secondary objectives include the description of ventilator settings among different countries, and their association with outcomes. Inclusion criteria will be adult patients admitted to the intensive care unit (ICU) with a diagnosis of traumatic brain injury or cerebrovascular diseases (intracranial haemorrhage, subarachnoid haemorrhage, ischaemic stroke), requiring intubation and mechanical ventilation and admission to the ICU. Exclusion criteria will be the following: patients aged <18 years; pregnant patients; patients not intubated or not mechanically ventilated or receiving only non-invasive ventilation. Data related to clinical examination, neuromonitoring if available, ventilator settings and arterial blood gases will be recorded at admission and daily for the first 7 days and then at day 10 and 14. The Glasgow Outcome Scale Extended on mortality and neurological outcome will be collected at discharge from ICU, hospital and at 6 months follow-up.

Ethics and dissemination: The study has been approved by the Ethic committee of Brianza at the Azienda Socio Sanitaria Territoriale-Monza. Data will be disseminated to the scientific community by abstracts submitted to the European Society of Intensive Care Medicine annual conference and by original articles submitted to peer-reviewed journals.

Trial registration number: NCT04459884.

Keywords: adult intensive & critical care; neurological injury; neurophysiology.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Timetable of the study. ABGs, arterial blood gases; GOSE, Glasgow Outcome Scale Extended; ICU, intensive care unit.

References

    1. Borsellino B, Schultz MJ, Gama de Abreu M, et al. . Mechanical ventilation in neurocritical care patients: a systematic literature review. Expert Rev Respir Med 2016;10:1123–32. 10.1080/17476348.2017.1235976
    1. Slutsky AS. Lung injury caused by mechanical ventilation. Chest 1999;116:9S–15. 10.1378/chest.116.suppl_1.9S-a
    1. Robba C, Bonatti G, Battaglini D, et al. . Mechanical ventilation in patients with acute ischaemic stroke: from pathophysiology to clinical practice. Crit Care 2019;23:388. 10.1186/s13054-019-2662-8
    1. Samary CS, Ramos AB, Maia LA, et al. . Focal ischemic stroke leads to lung injury and reduces alveolar macrophage phagocytic capability in rats. Crit Care 2018;22:249. 10.1186/s13054-018-2164-0
    1. Heuer JF, Pelosi P, Hermann P, et al. . Acute effects of intracranial hypertension and ARDS on pulmonary and neuronal damage: a randomized experimental study in pigs. Intensive Care Med 2011;37:1182–91. 10.1007/s00134-011-2232-2
    1. Putensen C, Theuerkauf N, Zinserling J, et al. . Meta-analysis: ventilation strategies and outcomes of the acute respiratory distress syndrome and acute lung injury. Ann Intern Med 2009;151:566–76. 10.7326/0003-4819-151-8-200910200-00011
    1. Saddy F, Sutherasan Y, Rocco PRM, et al. . Ventilator-Associated lung injury during assisted mechanical ventilation. Semin Respir Crit Care Med 2014;35:409–17. 10.1055/s-0034-1382153
    1. Esteban A, Ferguson ND, Meade MO, et al. . Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Care Med 2008;177:170–7. 10.1164/rccm.200706-893OC
    1. Matthay MA, Ware LB, Zimmerman GA. The acute respiratory distress syndrome. J Clin Invest 2012;122:2731–40. 10.1172/JCI60331
    1. Needham DM, Colantuoni E, Mendez-Tellez PA, et al. . Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study. BMJ 2012;344:e2124. 10.1136/bmj.e2124
    1. Sage M, See W, Nault S, et al. . Effect of low versus high Tidal-Volume total liquid ventilation on pulmonary inflammation. Front Physiol 2020;11:603. 10.3389/fphys.2020.00603
    1. Dellinger RP, Levy MM, Rhodes A, et al. . Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41:580–637. 10.1097/CCM.0b013e31827e83af
    1. Determann RM, Royakkers A, Wolthuis EK, et al. . Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Crit Care 2010;14:R1. 10.1186/cc8230
    1. Serpa Neto A, Cardoso SO, Manetta JA, et al. . Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA 2012;308:1651–9. 10.1001/jama.2012.13730
    1. Stevens RD, Lazaridis C, Chalela JA. The role of mechanical ventilation in acute brain injury. Neurol Clin 2008;26:543–63. 10.1016/j.ncl.2008.03.014
    1. Cinotti R, Bouras M, Roquilly A, et al. . Management and weaning from mechanical ventilation in neurologic patients. Ann Transl Med 2018;6:381. 10.21037/atm.2018.08.16
    1. Della Torre V, Badenes R, Corradi F, et al. . Acute respiratory distress syndrome in traumatic brain injury: how do we manage it? J Thorac Dis 2017;9:5368–81. 10.21037/jtd.2017.11.03
    1. Robba C, Poole D, McNett M, et al. . Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of intensive care medicine consensus. Intensive Care Med 2020;46:2397–410. 10.1007/s00134-020-06283-0
    1. Wilson JT, Pettigrew LE, Teasdale GM. Structured interviews for the Glasgow outcome scale and the extended Glasgow outcome scale: guidelines for their use. J Neurotrauma 1998;15:573–85. 10.1089/neu.1998.15.573
    1. Citerio G, Prisco L, Oddo M, et al. . International prospective observational study on intracranial pressure in intensive care (ICU): the SYNAPSE-ICU study protocol. BMJ Open 2019;9:e026552. 10.1136/bmjopen-2018-026552
    1. Frisvold SK, Robba C, Guérin C. What respiratory targets should be recommended in patients with brain injury and respiratory failure? Intensive Care Med 2019;45:683–6. 10.1007/s00134-019-05556-7
    1. Pelosi P, Ferguson ND, Frutos-Vivar F, et al. . Management and outcome of mechanically ventilated neurologic patients. Crit Care Med 2011;39:1482–92. 10.1097/CCM.0b013e31821209a8
    1. Koutsoukou A, Perraki H, Raftopoulou A, et al. . Respiratory mechanics in brain-damaged patients. Intensive Care Med 2006;32:1947–54. 10.1007/s00134-006-0406-0
    1. Nortje J, Coles JP, Timofeev I, et al. . Effect of hyperoxia on regional oxygenation and metabolism after severe traumatic brain injury: preliminary findings. Crit Care Med 2008;36:273–81. 10.1097/01.CCM.0000292014.60835.15
    1. Hawryluk GWJ, Aguilera S, Buki A, et al. . A management algorithm for patients with intracranial pressure monitoring: the Seattle international severe traumatic brain injury consensus conference (SIBICC). Intensive Care Med 2019;45:1783–94. 10.1007/s00134-019-05805-9
    1. Carney N, Totten AM, O'Reilly C, et al. . Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery 2017;80:6–15. 10.1227/NEU.0000000000001432
    1. Karalapillai D, Weinberg L, Peyton P, et al. . Effect of intraoperative low tidal volume vs conventional tidal volume on postoperative pulmonary complications in patients undergoing major surgery: a randomized clinical trial. JAMA 2020;324:848–58. 10.1001/jama.2020.12866
    1. Serpa Neto A, Simonis FD, Barbas CSV, et al. . Association between tidal volume size, duration of ventilation, and sedation needs in patients without acute respiratory distress syndrome: an individual patient data meta-analysis. Intensive Care Med 2014;40:950–7. 10.1007/s00134-014-3318-4
    1. Caricato A, Conti G, Della Corte F, et al. . Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: the role of respiratory system compliance. J Trauma 2005;58:571–6. 10.1097/01.TA.0000152806.19198.DB
    1. Robba C, Ortu A, Bilotta F, et al. . Extracorporeal membrane oxygenation for adult respiratory distress syndrome in trauma patients: a case series and systematic literature review. J Trauma Acute Care Surg 2017;82:165–73. 10.1097/TA.0000000000001276
    1. Tejerina E, Pelosi P, Muriel A, et al. . Association between ventilatory settings and development of acute respiratory distress syndrome in mechanically ventilated patients due to brain injury. J Crit Care 2017;38:341–5. 10.1016/j.jcrc.2016.11.010
    1. Neto AS, Barbas CSV, Simonis FD, et al. . Epidemiological characteristics, practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries (PRoVENT): an international, multicentre, prospective study. Lancet Respir Med 2016;4:882–93. 10.1016/S2213-2600(16)30305-8
    1. , Simonis FD, Serpa Neto A, et al. , Writing Group for the PReVENT Investigators . Effect of a low vs intermediate tidal volume strategy on ventilator-free days in intensive care unit patients without ARDS: a randomized clinical trial. JAMA 2018;320:1872–80. 10.1001/jama.2018.14280
    1. Serpa Neto A, Hemmes SNT, Barbas CSV, et al. . Protective versus conventional ventilation for surgery: a systematic review and individual patient data meta-analysis. Anesthesiology 2015;123:66–78. 10.1097/ALN.0000000000000706

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel