This international cohort study involving 1,510 patients with Acute Brain Injury (ABI) across 73 ICUs investigated the impact of Low-Tidal-Volume Ventilation (LTVV) on outcomes.

In this group, where the most common etiology was Traumatic Brain Injury (48.1%) and only 9.2% developed ARDS, LTVV—defined as tidal volumes of 8 mL/kg Predicted Body Weight (PBW) or less-was strongly associated with improved survival.

Specifically, patients who received LTVV during the first seven days of mechanical ventilation had a significantly lower adjusted incidence of ICU mortality up to 60 days (40.2%) compared to those receiving tidal volumes greater than 8 mL/kg PBW (59.7%), resulting in a favorable marginal hazard ratio of 0.54.

The protective association of LTVV persisted across all subgroup analyses, suggesting a consistent benefit in the ABI population.

However, the associations were less clear when investigating even lower LTVV thresholds.

The findings advocate for the routine use of lung-protective LTVV in mechanically ventilated ABI patients, even in the absence of ARDS.

Future research is warranted to specifically examine the effects of LTVV in the subgroup of ABI patients who do develop ARDS, to investigate even lower tidal volume targets, and to assess the impact of LTVV on functional outcomes and adverse events beyond mortality.

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