Approaches to Mechanical Ventilation in Patients With and Without Acute Brain Injury: A Registry-Based Cohort Study
Bibliographic record
Abstract
OBJECTIVES: Differences in mechanical ventilation strategies between patients with and without acute brain injury (ABI) remain incompletely characterized. We aimed to compare ventilation approaches in patients with and without ABI over a 10-year period and to investigate impacts of practice changes on Pa o2 and Pa co2 . DESIGN: Retrospective registry-based cohort study involving prospectively collected data from nine ICUs across Toronto, Ontario, Canada. SETTING AND PATIENTS: Adult patients (≥ 18 yr) receiving invasive ventilation for at least 48 hours from 2014 to 2023 were included. Patients were classified as having ABI (exposure) or non-ABI (comparator) conditions. Between-group differences in tidal volume (V t ), positive end-expiratory pressure (PEEP), Pa co2 , and Pa o2 were summarized using adjusted linear mixed-effects regression. Six additional ventilation and gas exchange variables were evaluated in unadjusted analyses. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Thirteen thousand nine hundred twenty-five patients were included. Mean age ( sd ) was 59.1 years (17.5 yr), 38.1% of patients ( n = 5305) were female, and 25.2% had ABI ( n = 3503). Over the first 7 ventilation days, V t was comparable between groups, with a daily median close to 6 mL/kg (interquartile range, 6-7 mL/kg) predicted body weight. PEEP was significantly lower in patients with ABI (median 5 vs. 8 cm H 2 O in non-ABI patients; p < 0.001). Among patients with hypoxemic respiratory failure, PEEP remained significantly lower in the ABI subset. From 2014 to 2023, V t decreased slightly in both groups, while PEEP remained unchanged. Pa co2 was largely maintained within 35-45 mm Hg in ABI patients and Pa o2 remained largely within 80-120 mm Hg. Differences in six additional ventilation parameters between groups were minimal. CONCLUSIONS: Both ABI and non-ABI patients received comparable V t that trended downwards over time. Pa co2 and Pa o2 remained largely within guideline-recommended ranges. However, PEEP was significantly lower in ABI patients, including among those with hypoxemic respiratory failure, highlighting potential opportunities to improve PEEP application in relevant subsets.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".