Efficiency of a Protective Mode of Mechanical Ventilation in Patients with Severe Traumatic Brain Injury Complicated by Acute Respiratory Distress Syndrome

TL;DR

This study shows that using lung-protective ventilation in patients with severe brain injury and lung issues improves survival without harming brain outcomes.

Contribution

The study demonstrates that lung-protective ventilation reduces mortality in severe TBI patients with ARDS.

Findings

Lung-protective ventilation reduced mortality from 78.6% to 31.4%.

Mortality was associated with lower GCS, reduced PaO2/FiO2 ratio, higher tidal volume, and lower PEEP.

Lung-protective ventilation did not compromise cerebral outcomes.

Abstract

Background/Objectives: Treatment of severe traumatic brain injury (TBI) remains a major challenge in neurocritical care. The functional state of the brain largely depends on the applied ventilation strategy. Many patients develop acute respiratory distress syndrome (ARDS), for which lung-protective ventilation is recommended. However, its effect on outcomes in severe TBI remains unclear. This study aimed to assess whether a lung-protective ventilation strategy improves short-term outcomes in patients with severe TBI complicated by ARDS. Methods: This multicenter retrospective study included patients with severe TBI and ARDS treated in three Ukrainian tertiary hospitals. Lung-protective ventilation was defined as the use of a low tidal volume and moderate positive end-expiratory pressure (PEEP). The primary endpoint was 28-day mortality; secondary endpoints included the Glasgow Coma Scale (GCS) score and intracranial pressure (ICP) on day 28. Univariate and multivariate logistic regression analyses identified factors associated with mortality. Results: Mortality did not depend on arterial PaO2 (p = 0.173) but correlated with lower GCS (p < 0.001), reduced PaO2/FiO2 ratio (p < 0.001), higher tidal volume (p < 0.001), and lower PEEP (p < 0.001). Lung-protective ventilation reduced mortality from 78.6% to 31.4%. Conclusions: Lung-protective ventilation is safe and effective in severe TBI with ARDS, significantly improving short-term survival without compromising cerebral outcomes.

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