• Eva E Tejerina, Paolo Pelosi, Chiara Robba, Oscar Peñuelas, Alfonso Muriel, Deisy Barrios, Fernando Frutos-Vivar, Konstantinos Raymondos, Bin Du, Arnaud W Thille, Fernando Ríos, Marco González, Lorenzo Del-Sorbo, MarínMaria Del CarmenMDCHospital Regional 1° de Octubre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), México DF, México., Valle PinheiroBrunoBPulmonary Research Laboratory, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil., Marco Antonio Soares, Nicolas Nin, Salvatore M Maggiore, Andrew Bersten, Pravin Amin, Nahit Cakar, Young SuhGeeGCenter for Clinical Epidemiology of Samsung Medical Center, Seoul, South Korea., Fekri Abroug, Manuel Jibaja, Dimitros Matamis, Ali ZeggwaghAmineACentre Hospitalier Universitarie Ibn Sina-Mohammed V University, Rabat, Morocco., Yuda Sutherasan, Antonio Anzueto, Andrés Esteban, and VENTILA Group.
• Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
• Crit. Care Med. 2021 Jul 1; 49 (7): 109511061095-1106.

ObjectivesTo describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality.DesignSecondary analysis of three prospective, observational, multicenter studies.SettingCohort studies conducted in 2004, 2010, and 2016.PatientsAdult patients who received mechanical ventilation for more than 12 hours.InterventionsNone.Measurements And Main ResultsAmong the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma.ConclusionsMore lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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