Association between ventilatory settings and development of acute respiratory distress syndrome in mechanically ventilated patients due to brain injury.

Abstract

PURPOSE:

In neurologically critically ill patients with mechanical ventilation (MV), the development of acute respiratory distress syndrome (ARDS) is a major contributor to morbidity and mortality, but the role of ventilatory management has been scarcely evaluated. We evaluate the association of tidal volume, level of PEEP and driving pressure with the development of ARDS in a population of patients with brain injury.

MATERIALS AND METHODS:

We performed a secondary analysis of a prospective, observational study on mechanical ventilation.

RESULTS:

We included 986 patients mechanically ventilated due to an acute brain injury (hemorrhagic stroke, ischemic stroke or brain trauma). Incidence of ARDS in this cohort was 3%. Multivariate analysis suggested that driving pressure could be associated with the development of ARDS (odds ratio for unit increment of driving pressure 1.12; confidence interval for 95%: 1.01 to 1.23) whereas we did not observe association for tidal volume (in ml per kg of predicted body weight) or level of PEEP. ARDS was associated with an increase in mortality, longer duration of mechanical ventilation, and longer ICU length of stay.

CONCLUSIONS:

In a cohort of brain-injured patients the development of ARDS was not common. Driving pressure was associated with the development of this disease.

• Authors: Eva Tejerina, Paolo Pelosi, Alfonso Muriel, Oscar Peñuelas, Yuda Sutherasan, Fernando Frutos-Vivar, Nicolás Nin, Andrew R Davies, Fernando Rios, Damian A Violi, Konstantinos Raymondos, Javier Hurtado, Marco González, Bin Du, Pravin Amin, Salvatore M Maggiore, Arnaud W Thille, Marco Antonio Soares, Manuel Jibaja, Asisclo J Villagomez, Michael A Kuiper, Younsuck Koh, Rui P Moreno, Amine Ali Zeggwagh, Dimitrios Matamis, Antonio Anzueto, Niall D Ferguson, Andrés Esteban, for VENTILA group
• Journal: Journal of critical care (J Crit Care) Vol. 38 Pg. 341-345 (04 2017) ISSN: 1557-8615 [Electronic] United States
• PMID: 27914908 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Brain Injuries (therapy)
• Critical Illness
• Female
• Glasgow Coma Scale
• Humans
• Incidence
• Intensive Care Units
• Length of Stay
• Male
• Middle Aged
• Morbidity
• Mortality
• Multivariate Analysis
• Positive-Pressure Respiration
• Pressure
• Prospective Studies
• Respiration, Artificial (methods)
• Respiratory Distress Syndrome (epidemiology)
• Risk Factors
• Tidal Volume
• Time Factors