Evidence map›Paper›PMID 33175276›Full record

ArticleIntensive care medicine2020

Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus.

Chiara Robba, Daniele Poole, Molly McNett, Karim Asehnoune, Julian Bösel, Nicolas Bruder, Arturo Chieregato, Raphael Cinotti, Jacques Duranteau, Sharon Einav and 21 more

Registry-linked trialOpen access · bronzeAbstract readConsensus Statement
PubMed Full text at PMC Publisher
In one paragraph

Article in Intensive care medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05464277 (Impact of Intermediate Normal Compared to High Normal Oxygen Levels on Outcomes of Patients Presenting in the Emergency Department With Severe Traumatic Brain Injury), which is not on this map. Cited by 147 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
147citing papers in PubMed, 8 pooled it
18.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05464277 naterminatednot on this mapstarted 2022, after this paper: background citation

Impact of Intermediate Normal Compared to High Normal Oxygen Levels on Outcomes of Patients Presenting in the Emergency Department With Severe Traumatic Brain Injury (INACHOS): a Pilot Randomized Controlled Trial

TypeinterventionalSponsorEvangelismos HospitalRan2022 to 2024Enrolled1ConditionsTraumatic Brain Injury, Acute Respiratory Failure, Acute Respiratory Distress Syndrome, Acute Brain InjuryArmsOxygen
3 · Its place in the literature

Who cites it

147 citing papers in PubMed, 8 syntheses or guidelines pooled it, 323 citations in OpenAlex.

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  9. Comparative Analysis of 5 cmH₂O Versus 10 cmH₂O PEEP on Cerebral Oxygen Saturation in Brain Tumor Surgery: A Randomized Controlled Clinical Study.Medical science monitor : international medical journal of experimental and clinical research · 2025
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  20. ARDS management in trauma patients.Intensive care medicine · 2026
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87 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

31 authors at 20 institutions in 15 countries.

Chiara RobbaSan Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
Daniele PooleAnesthesia and Intensive Care Operative Unit, S. Martino Hospital, Belluno, Italy.
Molly McNettImplementation Science, The Helene Fuld Health Trust National Institute for EBP, College of Nursing, The Ohio State University, Columbus, OH, USA.
Karim AsehnouneDepartment of Anaesthesia and Critical Care, Hôtel Dieu, University Hospital of Nantes, Nantes, France.
Julian BöselDepartment of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
Nicolas BruderAnesthesiology-Intensive Care Department, Aix-Marseille University, APHM, CHU Timone, Marseille, France.
Arturo ChieregatoNeurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Raphael CinottiDepartment of Anaesthesia and Critical Care, Hôpital Guillaume et René Laennec, University Hospital of Nantes, Saint-Herblain, France.
Jacques DuranteauDepartment of Anesthesiology and Perioperative Intensive Care Medicine, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Paris-Saclay University, Paris, France.
Sharon EinavFaculty of Medicine, Intensive Care Unit of the Shaare Zedek Medical Centre and Hebrew University, Jerusalem, Israel.
Ari ErcoleUniversity of Cambridge Division of Anaesthesia, Addenbrooke's Hospital, Cambridge, UK.
Niall FergusonInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Claude GuerinMedecine Intensive-Réanimation, Hopital Edouard Herriot, University of Lyon, Lyon, France.
Ilias I SiemposFirst Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
Pedro KurtzDepartment of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil.
Nicole P JuffermansDepartment of Intensive Care Medicine, Olvg Hospital, Amsterdam, The Netherlands.
Jordi ManceboServei Medicina Intensiva, Hospital Sant Pau, Barcelona, Spain.
Luciana MasciaAlma Mater Studiorum, Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.
Victoria McCredieInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Nicolas NinDepartment of Intensive Care Medicine, Hospital Español, Montevideo, Uruguay.
Mauro OddoDepartment of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland.
Paolo PelosiSan Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
Alejandro A RabinsteinDepartment of Neurology, Mayo Clinic, Rochester, MN, USA.
Ary Serpa NetoAustralian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
David B SederDepartment of Critical Care Services, Neuroscience Institute, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA.
Markus B SkrifvarsDepartment of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Meilahden sairaala, Haartmaninkatu 4, 00029 HUS, Helsinki, Finland.
Jose I SuarezDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Phipps 455, Baltimore, MD, 21287, USA.
Fabio Silvio TacconeDepartment of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Mathieu van der JagtDepartment of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands.
Giuseppe CiterioSchool of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy.ORCID 0000-0002-5374-3161
Robert D StevensDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Phipps 455, Baltimore, MD, 21287, USA. rstevens@jhmi.edu.
Johns Hopkins University · USOspedale Policlinico San Martino · ITUniversity of Toronto · CAAix-Marseille Université · FRAzienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda · ITErasmus MC · NLHeidelberg University · DEHôpital Laennec · FRHospital de Sant Pau · ESHospital Israelita Albert Einstein · BRInstituto Estadual do Cérebro Paulo Niemeyer · BRMaine Medical Center · USMayo Clinic in Arizona · USNewYork–Presbyterian Hospital · USOLVG · NLShaare Zedek Medical Center · ILThe Ohio State University · USUniversité Claude Bernard Lyon 1 · FRUniversité Libre de Bruxelles · BEUniversité Paris-Saclay · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo provide clinical practice recommendations and generate a research agenda on mechanical ventilation and respiratory support in patients with acute brain injury (ABI).

methodsAn international consensus panel was convened including 29 clinician-scientists in intensive care medicine with expertise in acute respiratory failure, neurointensive care, or both, and two non-voting methodologists. The panel was divided into seven subgroups, each addressing a predefined clinical practice domain relevant to patients admitted to the intensive care unit (ICU) with ABI, defined as acute traumatic brain or cerebrovascular injury. The panel conducted systematic searches and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to evaluate evidence and formulate questions. A modified Delphi process was implemented with four rounds of voting in which panellists were asked to respond to questions (rounds 1-3) and then recommendation statements (final round). Strong recommendation, weak recommendation, or no recommendation were defined when > 85%, 75-85%, and < 75% of panellists, respectively, agreed with a statement.

resultsThe GRADE rating was low, very low, or absent across domains. The consensus produced 36 statements (19 strong recommendations, 6 weak recommendations, 11 no recommendation) regarding airway management, non-invasive respiratory support, strategies for mechanical ventilation, rescue interventions for respiratory failure, ventilator liberation, and tracheostomy in brain-injured patients. Several knowledge gaps were identified to inform future research efforts.

conclusionsThis consensus provides guidance for the care of patients admitted to the ICU with ABI. Evidence was generally insufficient or lacking, and research is needed to demonstrate the feasibility, safety, and efficacy of different management approaches.

Indexed as

Brain InjuriesRespiration, ArtificialCritical CareHumansIntensive Care UnitsAcute strokeARDSMechanical ventilationRespiratory failureSubarachnoid hemorrhageTraumatic brain injury

Identifiers

PMID33175276
PMCPMC7655906
OpenAlexW3099229474

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.