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

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://clinicaltrials.gov/ct2/show/NCT02517073.

journal_name

Chin Med J (Engl)

journal_title

Chinese medical journal

authors

Luo XY,Hu YH,Cao XY,Kang Y,Liu LP,Wang SH,Yu RG,Yu XY,Zhang X,Li BS,Ma ZX,Weng YB,Zhang H,Chen DC,Chen W,Chen WJ,Chen XM,Du B,Duan ML,Hu J,Huang YF,Jia GJ,Li LH,Liang YM,Qin BY,Wang XD,Xiong J,Yan LM

doi

10.4103/0366-6999.185869

subject

Has Abstract

pub_date

2016-07-20 00:00:00

pages

1643-51

issue

14

eissn

0366-6999

issn

2542-5641

pii

ChinMedJ_2016_129_14_1643_185869

journal_volume

129

pub_type

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