Neuroanesthesia & neurocritical care
Mechanical ventilation in patients with acute brain injury: a systematic review with meta-analysis
Authors' conclusion
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
Study context
- Population
- Patients with acute brain injury (trauma or haemorrhagic stroke) on invasive mechanical ventilation for ≥ 24 h
- Participants
- 5,639 patients · 8 studies
- Comparison
- Low vs high tidal volume (Vt < 8 vs >= 8 ml/Kg IBW); Positive end-expiratory pressure (PEEP) < 5 vs >= 5 cmH2O; protective vs non-protective ventilation
- Outcome
- Mortality at 28 days or in-hospital mortality
Methodological detailsobservational and interventional (before/after) studies
- Observational and interventional (before/after) studies
Pooled result
As reported in the abstract
Mortality
Odds ratio (95% CI)P value
Low tidal volume vs High tidal volumeI2 = 20%
0.88(0.74–1.05)
P = 0.16Low PEEP vs Moderate to high PEEPI2 = 80%
0.8(0.59–1.07)
P = 0.13Protective ventilation vs Non-protective ventilationI2 = 11
1.03(0.93–1.15)
P = 0.6Further pooled results
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Incidence of ARDSLow tidal volume vs High tidal volume · I2 = 88% | 0.74 (0.45–1.21) | P = 0.23 | |
| Incidence of ARDSModerate to high PEEP vs Low PEEP · moderate PEEP; I2 = 21% | 0.98 (0.76–1.26) | P = 0.9 | |
| Incidence of ARDSProtective ventilation vs Non-protective ventilation · I2 = 22% | 1.22 (0.94–1.58) | P = 0.13 | |
| 0.512Odds ratio (log scale) |
| Outcome | P value |
|---|---|
| PaO2/FiO2 ratio · first five days of mechanical ventilationProtective ventilation vs Non-protective ventilation | P < 0.01 |
Incidence of acute respiratory distress syndrome (ARDS)
- Did not affect ARDS incidence
PaO2/fraction of inspired oxygen (FiO2) ratio · first five days of mechanical ventilation
- Protective ventilation improved PaO2/FiO2 ratio
Original publication
Mechanical ventilation in patients with acute brain injury: a systematic review with meta-analysis. Crit Care. Published 6 June 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →