VENTIlatory strategies for patients with severe traumatic brain injury in the LOw- and Middle-Income CountrieS – The VENTILOMICS survey

Introduction - Traumatic brain injury (TBI) poses a significant global health challenge, particularly in low- and middle-income countries (LMICs), where the disease burden is exacerbated by limited resources and preventative measures. This study revisits the ‘VENTILatOry strategies in patients with severe traumatic brain injury’ (VENTILO) survey, focusing on ventilatory management practices among healthcare professionals in LMICs. Methodology - A cross-sectional online survey, VENTILOMICS, was conducted using the original VENTILO survey questionnaire, developed following a review of literature on respiratory management in TBI patients, captured demographics of participants, type of hospital/specialty and available neuromonitoring tools; protocols for mechanical ventilation and weaning, and respiratory management strategies. Descriptive statistics were computed for all study variables. We analyzed data based on the geographical location of the LMICs and their economic status. Results – There were 204 respondents from 28 LMICs. Our results indicate that 55-70% of respondents recommend tidal volumes (VT) of 6-8 ml/kg for patients with high or medium PaO2/FiO2 (P/F) ratios, while VT of 4-6 ml/kg is preferred for those with low P/F ratios. For patients with intracranial hypertension, lower positive end-expiratory pressure (PEEP) levels were utilized. Access to neuromonitoring tools was notably better in neuro-critical care units compared to general ICUs, with significant geo-economic disparities in practices and resource availability. Most respondents advocated for early tracheostomy, though preferences varied by region, particularly in Sub-Saharan Africa. Conclusion - The findings are suggestive of a consistent approach to lung-protective ventilation across LMICs, with notable variations influenced by local resources and economic status. This study highlights the necessity for tailored research and guidelines to address the specific challenges faced in TBI management within LMICs, thereby, advocating improved access to neuromonitoring techniques and standardized protocols.