Eva Tejerina1, Paolo Pelosi2, Alfonso Muriel3, Oscar Peñuelas4, Yuda Sutherasan5, Fernando Frutos-Vivar4, Nicolás Nin6, Andrew R Davies7, Fernando Rios8, Damian A Violi9, Konstantinos Raymondos10, Javier Hurtado11, Marco González12, Bin Du13, Pravin Amin14, Salvatore M Maggiore15, Arnaud W Thille16, Marco Antonio Soares17, Manuel Jibaja18, Asisclo J Villagomez19, Michael A Kuiper20, Younsuck Koh21, Rui P Moreno22, Amine Ali Zeggwagh23, Dimitrios Matamis24, Antonio Anzueto25, Niall D Ferguson26, Andrés Esteban4. 1. Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain. Electronic address: evateje@gmail.com. 2. Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST, Genoa, Italy. 3. Unidad de Bioestadística Clínica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS) & Centro de Investigación en Red de Epidemiología y Salud Pública (CIBERESP), Spain. 4. Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain. 5. Division of Pulmonary and Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 6. Hospital Universitario de Montevideo, Uruguay. 7. Alfred Hospital & Monash University, Melbourne, Australia. 8. Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina. 9. Hospital HIGA Guemes, Haedo, Argentina. 10. Medizinische Hochschule Hannover, Germany. 11. Hospital de Clínicas de Montevideo, Montevideo, Uruguay. 12. Clínica Medellín & Universidad Pontificia Bolivariana, Medellín, Colombia. 13. Peking Union Medical College Hospital, Beijing, People's Republic of China. 14. Bombay Hospital Institute of Medical Sciences, Mumbai, India. 15. Policlinico "Agostino Gemelli", Università Cattolica Del Sacro Cuore, Roma, Italy. 16. University Hospital of Poitiers, Poitiers, France. 17. Hospital Universitario Sao Jose, Belo Horizonte, Brazil. 18. Hospital Eugenio Espejo, Quito, Ecuador. 19. Hospital Regional 1° de Octubre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), México DF, México. 20. Medical Center Leeuwarden (MCL), Leeuwarden, The Netherlands. 21. Asan Medical Center, University of Ulsan, Seoul, Republic of Korea. 22. Hospital de Sao José, Centro Hospitalar de Lisboa Central, Lisbon, Portugal. 23. Hôpital Ibn Sina, Rabat, Morocco. 24. Papageorgiou Hospital, Thessaloniki, Greece. 25. South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, TX, USA. 26. Interdepartmental Division of Critical Care Medicine, and Departments of Medicine & Physiology, University of Toronto, Canada.
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.
PURPOSE: In neurologically critically illpatients 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.