Ventilation practices in acute brain injured patients and association with outcomes: the VENTIBRAIN multicenter observational study.

Summary

Across 74 ICUs in 26 countries (n=2095 ABI patients), protective ventilation was common but variable; admission Pplat had a median of 15 cmH2O. Ventilator settings during ICU stay were associated with ICU and 6‑month mortality but not with unfavorable neurological outcomes.

Key Findings

• International prospective cohort of 2,095 ABI patients across 74 ICUs documented daily ventilator settings through day 14.
• Protective ventilation strategies were common but varied substantially between countries.
• Ventilator settings during ICU stay were associated with increased ICU and 6‑month mortality.
• No association was found between ventilator settings and unfavorable 6‑month neurological outcome.

Clinical Implications

Adopt protective ventilation while minimizing unnecessary variability; monitor and titrate ventilator settings mindful of their association with mortality. The lack of association with neurological outcome suggests prioritizing systemic safety endpoints alongside neuroprotection.

Limitations

• Observational design limits causal inference; residual confounding likely
• Heterogeneity in practice patterns across countries may affect generalizability of specific thresholds

Future Directions

Randomized trials to test ventilator strategies tailored to ABI pathophysiology; development of consensus protocols to reduce harmful variability.