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Rethinking Mechanical Ventilation: Can Ventilation Mode Influence Long-Term Cognitive Outcomes in ICU Patients with
Clementina M van Rijn1,2, Marta Godoy-González3,4, Sol Fernández-Gonzalo3,5
1Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 GD Nijmegen, The Netherlands.
Journal of Clinical Medicine
|January 28, 2026
Summary
Longer invasive mechanical ventilation (IMV) via tracheostomy, not endotracheal intubation, was linked to better cognitive function post-ICU. Age and cognitive reserve also influenced outcomes, suggesting non-invasive ventilation warrants further study.
Area of Science:
- Critical Care Medicine
- Neuroscience
- Pulmonary Medicine
Background:
- Long-term cognitive impairment is a frequent complication for ICU patients requiring invasive mechanical ventilation (IMV).
- The causes of post-ICU cognitive dysfunction are multifactorial and not fully understood.
- Understanding factors influencing cognitive outcomes in ventilated patients is crucial for improving patient care.
Purpose of the Study:
- To investigate the association between the duration of IMV and cognitive function one year after ICU discharge.
- To examine the moderating effects of patient age and cognitive reserve on the IMV duration-cognitive function relationship.
- To explore potential differences in cognitive outcomes based on the method of IMV delivery (endotracheal intubation vs. tracheostomy).
Main Methods:
- Secondary analysis of data from a published study on COVID-19 ICU survivors.
- Neuropsychological assessments conducted one year post-discharge to evaluate cognitive function.
- Linear regression models employed to analyze associations between IMV duration, age, cognitive reserve, and cognitive outcomes.
Main Results:
- Invasive mechanical ventilation (IMV) duration was not significantly associated with cognitive performance in endotracheally intubated patients.
- Among tracheostomized patients, longer IMV duration correlated with better cognitive outcomes (Cohen's f² = 0.21).
- Age and cognitive reserve significantly modulated the relationship between IMV duration and cognitive outcomes, with cognitive reserve showing a strong positive association (f² = 0.67).
Conclusions:
- Invasive mechanical ventilation (IMV) via tracheostomy may be associated with better cognitive outcomes compared to endotracheal intubation, potentially due to reduced sedation and more efficient respiratory support.
- While tracheostomy-delivered IMV may offer cognitive benefits, it remains a form of positive pressure ventilation (PPV) with inherent risks.
- Further research evaluating non-invasive ventilation (NIV) modes is warranted to explore alternatives for optimizing cognitive function in critically ill patients.
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