Photo Credit: YakobchukOlena

The following is a summary of “Lung-Protective Mechanical Ventilation in Patients with Severe Acute Brain Injury: A Multicenter Randomized Clinical Trial (PROLABI),” published in the September 2024 issue of Pulmonology by Mascia et al. 

Lung-protective strategies using low Vt and moderate positive end-expiratory pressure (PEEP) are considered best practice in critical care, but their use in acute brain injury remains controversial due to concerns about carbon dioxide control and cerebral hemodynamic effects.  

Researchers conducted a retrospective study to investigate the hypothesis that ventilation with VT and higher PEEP would improve clinical outcomes in individuals with acute brain injury compared to conventional ventilation.  

They examined 190 adult patients with acute brain injury, randomly assigned to receive either a lung-protective or conventional ventilatory strategy. The primary outcome was a composite endpoint consisting of death, ventilator dependency, and acute respiratory distress syndrome (ARDS) on Day 28. Neurological outcomes were evaluated at ICU discharge using the Oxford Handicap Scale and at 6 months with the Glasgow Outcome Scale.  

The results showed that both groups had comparable baseline characteristics. In the intention-to-treat analysis, the composite outcome at 28 days was 61.5% in the lung-protective group and 45.3% in the conventional group (RR, 1.35; 95% CI, 1.03–1.79; P=0.025). The mortality was 28.9% and 15.1% (RR, 1.91; 95% CI, 1.06–3.42; P=0.02), ventilator dependency was 42.3% and 27.9% (RR, 1.52; 95% CI, 1.01–2.28; P=0.039), and ARDS incidence was 30.8% and 22.1% (RR, 1.39; 95% CI, 0.85–2.27; P=0.179), respectively. The trial was prematurely terminated due to funding issues.  

They concluded the patients with acute brain injury without ARDS, a lung-protective strategy, did not reduce mortality, ventilator dependency, or ARDS incidence and had no neurological benefit, requiring further validation in larger trials due to early termination. 

Source: atsjournals.org/doi/abs/10.1164/rccm.202402-0375OC