Lung-protective Ventilation in Patients with Brain Injury: A Multicenter Cross-sectional Study and Questionnaire Survey in China

Xu-Ying Luo, Ying-Hong Hu, Xiang-Yuan Cao, Yan Kang, Li-Ping Liu, Shou-Hong Wang, Rong-Guo Yu, Xiang-You Yu, Xia Zhang, Bao-Shan Li, Zeng-Xiang Ma, Yi-Bing Weng, Heng Zhang, De-Chang Chen, Wei Chen, Wen-Jin Chen, Xiu-Mei Chen, Bin Du, Mei-Li Duan, Jin Hu, Yun-Feng Huang, Gui-Jun Jia, Li-Hong Li, Yu-Min Liang, Bing-Yu Qin, Xian-Dong Wang, Jian Xiong, Li-Mei Yan, Zheng-Ping Yang, Chen-Ming Dong, Dong-Xin Wang, Qing-Yuan Zhan, Shuang-Lin Fu, Lin Zhao, Qi-Bing Huang, Ying-Guang Xie, Xiao-Bo Huang, Guo-Bin Zhang, Wang-Bin Xu, Yuan Xu, Ya-Ling Liu, He-Ling Zhao, Rong-Qing Sun, Ming Sun, Qing-Hong Cheng, Xin Qu, Xiao-Feng Yang, Ming Xu, Zhong-Hua Shi, Han Chen, Xuan He, Yan-Lin Yang, Guang-Qiang Chen, Xiu-Mei Sun, Jian-Xin Zhou, Acute Brain Injury and Critical Care Research Collaboration (ABC Research Collaboration), Xu-Ying Luo, Ying-Hong Hu, Xiang-Yuan Cao, Yan Kang, Li-Ping Liu, Shou-Hong Wang, Rong-Guo Yu, Xiang-You Yu, Xia Zhang, Bao-Shan Li, Zeng-Xiang Ma, Yi-Bing Weng, Heng Zhang, De-Chang Chen, Wei Chen, Wen-Jin Chen, Xiu-Mei Chen, Bin Du, Mei-Li Duan, Jin Hu, Yun-Feng Huang, Gui-Jun Jia, Li-Hong Li, Yu-Min Liang, Bing-Yu Qin, Xian-Dong Wang, Jian Xiong, Li-Mei Yan, Zheng-Ping Yang, Chen-Ming Dong, Dong-Xin Wang, Qing-Yuan Zhan, Shuang-Lin Fu, Lin Zhao, Qi-Bing Huang, Ying-Guang Xie, Xiao-Bo Huang, Guo-Bin Zhang, Wang-Bin Xu, Yuan Xu, Ya-Ling Liu, He-Ling Zhao, Rong-Qing Sun, Ming Sun, Qing-Hong Cheng, Xin Qu, Xiao-Feng Yang, Ming Xu, Zhong-Hua Shi, Han Chen, Xuan He, Yan-Lin Yang, Guang-Qiang Chen, Xiu-Mei Sun, Jian-Xin Zhou, Acute Brain Injury and Critical Care Research Collaboration (ABC Research Collaboration)

Abstract

Background: Over the years, the mechanical ventilation (MV) strategy has changed worldwide. The aim of the present study was to describe the ventilation practices, particularly lung-protective ventilation (LPV), among brain-injured patients in China.

Methods: This study was a multicenter, 1-day, cross-sectional study in 47 Intensive Care Units (ICUs) across China. Mechanically ventilated patients (18 years and older) with brain injury in a participating ICU during the time of the study, including traumatic brain injury, stroke, postoperation with intracranial tumor, hypoxic-ischemic encephalopathy, intracranial infection, and idiopathic epilepsy, were enrolled. Demographic data, primary diagnoses, indications for MV, MV modes and settings, and prognoses on the 60th day were collected. Multivariable logistic analysis was used to assess factors that might affect the use of LPV.

Results: A total of 104 patients were enrolled in the present study, 87 (83.7%) of whom were identified with severe brain injury based on a Glasgow Coma Scale ≤8 points. Synchronized intermittent mandatory ventilation (SIMV) was the most frequent ventilator mode, accounting for 46.2% of the entire cohort. The median tidal volume was set to 8.0 ml/kg (interquartile range [IQR], 7.0-8.9 ml/kg) of the predicted body weight; 50 (48.1%) patients received LPV. The median positive end-expiratory pressure (PEEP) was set to 5 cmH2O (IQR, 5-6 cmH2O). No PEEP values were higher than 10 cmH2O. Compared with partially mandatory ventilation, supportive and spontaneous ventilation practices were associated with LPV. There were no significant differences in mortality and MV duration between patients subjected to LPV and those were not.

Conclusions: Among brain-injured patients in China, SIMV was the most frequent ventilation mode. Nearly one-half of the brain-injured patients received LPV. Patients under supportive and spontaneous ventilation were more likely to receive LPV.

Trial registration: ClinicalTrials.org NCT02517073 https://ichgcp.net/clinical-trials-registry/NCT02517073.

Figures

Figure 1
Figure 1
Flowchart of patients into the study. ICU: Intensive Care Unit; MV: Mechanical ventilation; SBT: Spontaneous breathing trial; NPPV: Noninvasive positive pressure ventilation.

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Source: PubMed

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