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Open Access 01-12-2023 | Acute Respiratory Distress-Syndrome | Research

Mechanical ventilation in patients with acute brain injury: a systematic review with meta-analysis

Authors: Karim Asehnoune, Paul Rooze, Chiara Robba, Marwan Bouras, Luciana Mascia, Raphaël Cinotti, Paolo Pelosi, Antoine Roquilly

Published in: Critical Care | Issue 1/2023

Abstract

Objective

To describe the potential effects of ventilatory strategies on the outcome of acute brain-injured patients undergoing invasive mechanical ventilation.

Design

Systematic review with an individual data meta-analysis.

Setting

Observational and interventional (before/after) studies published up to August 22nd, 2022, were considered for inclusion. We investigated the effects of low tidal volume Vt < 8 ml/Kg of IBW versus Vt > = 8 ml/Kg of IBW, positive end-expiratory pressure (PEEP) < or > = 5 cmH₂O and protective ventilation (association of both) on relevant clinical outcomes.

Population

Patients with acute brain injury (trauma or haemorrhagic stroke) with invasive mechanical ventilation for ≥ 24 h.

Main outcome measures

The primary outcome was mortality at 28 days or in-hospital mortality. Secondary outcomes were the incidence of acute respiratory distress syndrome (ARDS), the duration of mechanical ventilation and the partial pressure of oxygen (PaO₂)/fraction of inspired oxygen (FiO₂) ratio.

Results

The meta-analysis included eight studies with a total of 5639 patients. There was no difference in mortality between low and high tidal volume [Odds Ratio, OR 0.88 (95%Confidence Interval, CI 0.74 to 1.05), p = 0.16, I² = 20%], low and moderate to high PEEP [OR 0.8 (95% CI 0.59 to 1.07), p = 0.13, I² = 80%] or protective and non-protective ventilation [OR 1.03 (95% CI 0.93 to 1.15), p = 0.6, I² = 11]. Low tidal volume [OR 0.74 (95% CI 0.45 to 1.21, p = 0.23, I² = 88%], moderate PEEP [OR 0.98 (95% CI 0.76 to 1.26), p = 0.9, I² = 21%] or protective ventilation [OR 1.22 (95% CI 0.94 to 1.58), p = 0.13, I² = 22%] did not affect the incidence of acute respiratory distress syndrome. Protective ventilation improved the PaO₂/FiO₂ ratio in the first five days of mechanical ventilation (p < 0.01).

Conclusions

Low tidal volume, moderate to high PEEP, or protective ventilation were not associated with mortality and lower incidence of ARDS in patients with acute brain injury undergoing invasive mechanical ventilation. However, protective ventilation improved oxygenation and could be safely considered in this setting. The exact role of ventilatory management on the outcome of patients with a severe brain injury needs to be more accurately delineated.

Available only for authorised users

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Title: Mechanical ventilation in patients with acute brain injury: a systematic review with meta-analysis
Authors: Karim Asehnoune
Paul Rooze
Chiara Robba
Marwan Bouras
Luciana Mascia
Raphaël Cinotti
Paolo Pelosi
Antoine Roquilly
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Acute Respiratory Distress-Syndrome
Published in: Critical Care / Issue 1/2023
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-023-04509-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Mechanical ventilation in patients with acute brain injury: a systematic review with meta-analysis

Abstract

Objective

Design

Setting

Population

Main outcome measures

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Design

Setting

Population

Main outcome measures

Results

Conclusions

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