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

Abstract

a b s t r a c t a r t i c l e i n f oPurpose: 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 For personal use only. No other uses without permission. Copyright ©2017. Elsevier Inc. All rights reserved. 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.

Driving pressure and acute respiratory distress syndrome in critically ill patients

“…Recent studies suggest a role of ΔP in the risk of developing VILI in ARDS patients under extracorporeal membrane oxygenation or with brain injury . In addition, ΔP and Pplat were associated with mortality and development of ARDS in patients who presented to the emergency department requiring mechanical ventilation .…”

Intracranial-to-Central Venous Pressure Gap Predicts the Responsiveness of Intracranial Pressure to PEEP in Patients with Traumatic Brain Injury: a Prospective Cohort Study

“…In the current study, all the enrolled patients had normal compliance (Table 1). In addition, recent studies have challenged the effects of PEEP on ICP, arguing that PEEP may be more related to eventual changes in hemodynamics or lung compliance than affecting CVP [30][31][32]. For example, it was proposed that ICP markedly increases after PEEP application, but only in case PEEP induces alveolar hyperinflation with subsequent PaCO 2 increase [30].…”

Effect of Cerebral Perfusion Pressure on Acute Respiratory Distress Syndrome

“…The association of ΔP and ARDS has also been demonstrated in a recent multicenter observational study in neurocritically ill patients. 23 Physiologically, the development of ARDS may pose significant concerns for patients with TBI. First, ARDS can cause profound arterial hypoxemia which is associated with concomitant brain hypoxia and secondary injury.…”