Evidence map›Paper›PMID 40639639›Full record

Observational studyChest2025

Low-Tidal-Volume Ventilation and Mortality in Patients With Acute Brain Injury: A Secondary Analysis of an International Observational Study.

Julian F Daza, Doulia M Hamad, Martin Urner, Kuan Liu, Sarah Wahlster, Chiara Robba, Robert D Stevens, Victoria A McCredie, Raphael Cinotti, Shaurya Taran and 6 more

Registry-linked trialAbstract readObservational StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Chest, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03400904 (Gestion du Sevrage de la Ventilation mécanique du Patient neurolésé en réanimation et Association Avec le Devenir. Etude Observationnelle Multi-centrique Internationale. Extubation Strategies in Neuro-Intensive Care Unit Patients and Associations With Outcome. The International Observational ENIO Study.), which is not on this map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
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.

NCT03400904 completednot on this map

Gestion du Sevrage de la Ventilation mécanique du Patient neurolésé en réanimation et Association Avec le Devenir. Etude Observationnelle Multi-centrique Internationale. Extubation Strategies in Neuro-Intensive Care Unit Patients and Associations With Outcome. The International Observational ENIO Study.

TypeobservationalSponsorNantes University HospitalRan2018 to 2021Enrolled1,750ConditionsBrain InjuriesArmsPatients with brain injury and mechanical ventilation exposed to extubation/tracheostomy
3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Julian F DazaDivision of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Doulia M HamadDivision of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Martin UrnerInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
Kuan LiuInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Sarah WahlsterDepartment of Neurology, University of Washington School of Medicine, Seattle, WA; Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA; Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA.
Chiara RobbaIRCCS Policlinico San Martino, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
Robert D StevensDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD.
Victoria A McCredieInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Raphael CinottiUMR 1246 (Methods in Patient-Centered Outcomes and Health Research; SPHERE), Nantes Université (Nantes) and Tours Université (Tours), Nantes, France; Department of Anesthesia and Critical Care, CHU Nantes, Nantes Université, Hôtel-Dieu, Nantes, France.
Shaurya TaranInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: shaurya.taran@mail.utoronto.ca.
ENIO Study Group
PROtective VENTilation Network
European Society of Intensive Care Medicine
Colegio Mexicano de Medicina Critica
AtlanRéa Group
Société Française d’Anesthésie-Réanimation–SFAR Research Network

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLow-tidal-volume ventilation (LTVV) improves outcomes in critically ill patients, but its impact in patients with acute brain injuries (ABIs) is less certain. RESEARCH QUESTION: What is the association between LTVV and mortality in mechanically ventilated patients with ABI? STUDY DESIGN AND

methodsWe did a secondary analysis of a prospective observational study (NCT03400904; https://clinicaltrials.gov/study/NCT03400904). We compared LTVV (≤ 8 mL/kg predicted body weight [PBW]) with tidal volumes > 8 mL/kg PBW over the first 7 days of mechanical ventilation. Alternate analyses used lower thresholds for LTVV. Marginal structural Cox models were used to evaluate the association between LTVV and ICU mortality up to 60 days. Stabilized inverse probability treatment and censoring weights were generated using multivariable logistic regression adjusted for baseline and time-dependent confounders.

resultsA total of 1,510 patients from 73 ICUs across 18 countries were included. The mean age was 52 years, 513 patients (34.0%) were female, and the most common ABI etiology was traumatic brain injury (n = 726; 48.1%). ARDS developed in 137 patients (9.2%). In patients receiving LTVV, adjusted incidence of ICU mortality was 40.2% (95% CI, 19.2%-61.1%), vs 59.7% (95% CI, 44.0%-75.4%) in patients receiving tidal volumes > 8 mL/kg PBW (marginal hazard ratio, 0.54; 95% CI, 0.33-0.88). There was no heterogeneity of treatment effect in subgroup analyses, and sensitivity analyses for unmeasured confounding yielded similar results. However, associations were less clear at lower thresholds of LTVV.

interpretationIn this predominantly non-ARDS cohort of patients with ABI, LTVV over the first 7 days of mechanical ventilation was associated with lower ICU mortality up to 60 days, vs tidal volumes > 8 mL/kg PBW. Future research should investigate effects in patients with ABI and ARDS, use of lower LTVV thresholds, and impact on additional end points including functional outcomes and adverse events.

Indexed as

Brain InjuriesRespiration, ArtificialTidal VolumeAdultAgedCritical IllnessFemaleHospital MortalityHumansIntensive Care UnitsMaleMiddle AgedProspective Studiesacute brain injurylow-tidal-volume ventilationlung-protective ventilationneurocritical care

Identifiers

PMID40639639
PMCPMC12833485

What OpenQuestion holds

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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.