title: Association between ventilatory settings and development of acute respiratory distress syndrome in mechanically ventilated patients due to brain injury.
abstract: 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.
  
  
  
  We performed a secondary analysis of a prospective, observational study on mechanical ventilation.
  
  
  
  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.
  
  
  
  In a cohort of brain-injured patients the development of ARDS was not common. Driving pressure was associated with the development of this disease.
authors.affiliation: Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain. Electronic address: evateje@gmail.com.
authors.forename: Eva
authors.initials: E
authors.lastname: Tejerina
authors.affiliation: Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
authors.affiliation: 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.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
authors.affiliation: Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Peñuelas
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Yuda
authors.initials: Y
authors.lastname: Sutherasan
authors.affiliation: Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Frutos-Vivar
authors.affiliation: Hospital Universitario de Montevideo, Uruguay.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Nin
authors.affiliation: Alfred Hospital & Monash University, Melbourne, Australia.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Davies
authors.affiliation: Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rios
authors.affiliation: Hospital HIGA Guemes, Haedo, Argentina.
authors.forename: Damian A
authors.initials: DA
authors.lastname: Violi
authors.affiliation: Medizinische Hochschule Hannover, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Raymondos
authors.affiliation: Hospital de Clínicas de Montevideo, Montevideo, Uruguay.
authors.forename: Javier
authors.initials: J
authors.lastname: Hurtado
authors.affiliation: Clínica Medellín & Universidad Pontificia Bolivariana, Medellín, Colombia.
authors.forename: Marco
authors.initials: M
authors.lastname: González
authors.affiliation: Peking Union Medical College Hospital, Beijing, People's Republic of China.
authors.forename: Bin
authors.initials: B
authors.lastname: Du
authors.affiliation: Bombay Hospital Institute of Medical Sciences, Mumbai, India.
authors.forename: Pravin
authors.initials: P
authors.lastname: Amin
authors.affiliation: Policlinico "Agostino Gemelli", Università Cattolica Del Sacro Cuore, Roma, Italy.
authors.forename: Salvatore M
authors.initials: SM
authors.lastname: Maggiore
authors.affiliation: University Hospital of Poitiers, Poitiers, France.
authors.forename: Arnaud W
authors.initials: AW
authors.lastname: Thille
authors.affiliation: Hospital Universitario Sao Jose, Belo Horizonte, Brazil.
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Soares
authors.affiliation: Hospital Eugenio Espejo, Quito, Ecuador.
authors.forename: Manuel
authors.initials: M
authors.lastname: Jibaja
authors.affiliation: Hospital Regional 1° de Octubre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), México DF, México.
authors.forename: Asisclo J
authors.initials: AJ
authors.lastname: Villagomez
authors.affiliation: Medical Center Leeuwarden (MCL), Leeuwarden, The Netherlands.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuiper
authors.affiliation: Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
authors.forename: Younsuck
authors.initials: Y
authors.lastname: Koh
authors.affiliation: Hospital de Sao José, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
authors.forename: Rui P
authors.initials: RP
authors.lastname: Moreno
authors.affiliation: Hôpital Ibn Sina, Rabat, Morocco.
authors.forename: Amine Ali
authors.initials: AA
authors.lastname: Zeggwagh
authors.affiliation: Papageorgiou Hospital, Thessaloniki, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Matamis
authors.affiliation: South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
authors.affiliation: Interdepartmental Division of Critical Care Medicine, and Departments of Medicine & Physiology, University of Toronto, Canada.
authors.forename: Niall D
authors.initials: ND
authors.lastname: Ferguson
authors.affiliation: Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Esteban
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000628:therapy*; D016638:Critical Illness; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality; D015999:Multivariate Analysis; D011175:Positive-Pressure Respiration; D011312:Pressure; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000453:epidemiology*; D012307:Risk Factors; D013990:Tidal Volume; D013997:Time Factors
keywords: Acute respiratory distress syndrome; Driving pressure; Mechanical ventilation; Neurologic disease; Neurologically critically ill patients; Pulmonary complications