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Chin Med J (Engl). 2016 Jul 20;129(14):1643-51. doi: 10.4103/0366-6999.185869.

Lung-protective Ventilation in Patients with Brain Injury: A Multicenter Cross-sectional Study and Questionnaire Survey in China.

Author information

1
Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
2
Department of Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China.
3
Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China.
4
Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
5
Neurological Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
6
Department of Critical Care Medicine, Guangdong General Hospital, Guangzhou, Guangdong 510000, China.
7
Surgical Intensive Care Unit, Fujian Province Hospital, Fuzhou, Fujian 350000, China.
8
Department of Critical Care Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China.
9
Department of Critical Care Medicine, Bethune International Peace Hospital, Shijiazhuang, Hebei 050000, China.
10
Department of Critical Care Medicine, Yuncheng Central Hospital, Yuncheng, Shanxi 044000, China.
11
Department of Emergency and Critical Care Medicine, Cangzhou People's Hospital, Cangzhou, Hebei 061000, China.
12
Department of Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China.
13
Department of Critical Care Medicine, First Hospital of China Medical University, Shenyang, Liaoning 110000, China.
14
Department of Critical Care Medicine, Shanghai Changzheng Hospital, Shanghai 200000, China.
15
Department of Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
16
Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
17
Department of Critical Care Medicine, Miyun County Hospital, Beijing 100038, China.
18
Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing 101500, China.
19
Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
20
Department of Critical Care Medicine, Huashan Hospital of Shanghai Fudan University Medical College, Shanghai 200040, China.
21
Intensive Care Unit, Changsha Central Hospital, Changsha, Hunan 410018, China.
22
Department of Critical Care Medicine, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, China.
23
Department of Critical Care Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710000, China.
24
Neurosurgery Intensive Care Unit, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200240, China.
25
Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan 450000, China.
26
Department of Critical Care Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, China.
27
Department of Critical Care Medicine, General Hospital of Shenyang Military, Shenyang, Liaoning 110000, China.
28
Department of Critical Care Medicine, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia 010017, China.
29
Department of Critical Care Medicine, Qinghai Provincial People's Hospital, Xining, Qinghai 810000, China.
30
Department of Critical Care Medicine, Lanzhou University Second Hospital, Lanzhou, Gansu 730030, China.
31
Department of Critical Care Medicine, Peking University First Hospital, Beijing 100034, China.
32
Department of Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China.
33
Neurosurgery Intensive Care Unit, First Clinical Hospital, Norman Bethune College of Medicine, Jilin University, Changchun, Jilin 130000, China.
34
Department of Critical Care Medicine, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, China.
35
Department of Critical Care Medicine, Qilu Hospital of Shandong University, Ji'nan, Shandong 250012, China.
36
Department of Critical Care Medicine, Jining No. 1 People's Hospital, Jining, Shandong 272011, China.
37
Department of Critical Care Medicine, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, China.
38
Department of Critical Care Medicine, Tianjin Huanhu Hospital, Tianjin 300060, China.
39
Department of Emergency and Critical Care Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
40
Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100041, China.
41
Department of Critical Care Medicine, Beijing Pinggu Hospital, Beijing 101200, China.
42
Department of Critical Care Medicine, Hebei General Hospital, Shijiazhuang, Hebei 050051, China.
43
Department of Critical Care Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China.
44
Department of Critical Care Medicine, Liaocheng People's Hospital, Liaocheng, Shandong 252004, China.
45
Department of Critical Care Medicine, First Affiliated Hospital of The Medical College, Shihezi University, Shihezi, Xinjiang 832008, China.
46
Department of Critical Care Medicine, Shandong Provincial Hospital, Jinan, Shandong 250021, China.
47
Neurosurgery Intensive Care Unit, First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310003, China.

Abstract

BACKGROUND:

Over the years, the mechanical ventilation (MV) strategy has changed worldwide. The aim of the present study was to describe the ventilation practices, particularly lung-protective ventilation (LPV), among brain-injured patients in China.

METHODS:

This study was a multicenter, 1-day, cross-sectional study in 47 Intensive Care Units (ICUs) across China. Mechanically ventilated patients (18 years and older) with brain injury in a participating ICU during the time of the study, including traumatic brain injury, stroke, postoperation with intracranial tumor, hypoxic-ischemic encephalopathy, intracranial infection, and idiopathic epilepsy, were enrolled. Demographic data, primary diagnoses, indications for MV, MV modes and settings, and prognoses on the 60th day were collected. Multivariable logistic analysis was used to assess factors that might affect the use of LPV.

RESULTS:

A total of 104 patients were enrolled in the present study, 87 (83.7%) of whom were identified with severe brain injury based on a Glasgow Coma Scale ≤8 points. Synchronized intermittent mandatory ventilation (SIMV) was the most frequent ventilator mode, accounting for 46.2% of the entire cohort. The median tidal volume was set to 8.0 ml/kg (interquartile range [IQR], 7.0-8.9 ml/kg) of the predicted body weight; 50 (48.1%) patients received LPV. The median positive end-expiratory pressure (PEEP) was set to 5 cmH2O (IQR, 5-6 cmH2O). No PEEP values were higher than 10 cmH2O. Compared with partially mandatory ventilation, supportive and spontaneous ventilation practices were associated with LPV. There were no significant differences in mortality and MV duration between patients subjected to LPV and those were not.

CONCLUSIONS:

Among brain-injured patients in China, SIMV was the most frequent ventilation mode. Nearly one-half of the brain-injured patients received LPV. Patients under supportive and spontaneous ventilation were more likely to receive LPV.

TRIAL REGISTRATION:

ClinicalTrials.org NCT02517073 https://clinicaltrials.gov/ct2/show/NCT02517073.

PMID:
27411450
PMCID:
PMC4960952
DOI:
10.4103/0366-6999.185869
[Indexed for MEDLINE]
Free PMC Article

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