Respiratory elastance shapes outcome effects of tidal volume, rate

This post hoc analysis of the VENTIBRAIN study examined 1158 mechanically ventilated patients with acute brain injury to assess whether respiratory system elastance modifies associations between tidal volume, respiratory rate, and clinical outcomes. The study found that higher tidal volume was associated with lower ICU mortality in patients with low elastance but not in those with high elastance, and that the Bayesian optimal tidal volume decreased while optimal respiratory rate increased as elastance rose. The authors report that at constant alveolar ventilation, a 1-cmH2O increase in driving pressure carried a prognostic impact comparable to an approximately 3 breaths/min increase in respiratory rate, with findings consistent regardless of ARDS diagnosis.

Most relevant for: Mechanically ventilated patients with acute brain injury, including those with and without ARDS.

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