On mechanical ventilation? It affects the brain 'Every day less spent in the Intensive Care Unit is a win.'

2 March 2026

Mechanical ventilation saves lives, but it also carries risks and may even have consequences for the brain. Technical physician Jonne Doorduin of Radboud university medical center studies how ventilation disrupts brain activity and searches for new treatments. 'Every day less spent in the Intensive Care Unit is a win.'
Often called the cornerstone of intensive care, mechanical ventilation saves lives and gives patients time to recover from their illness. At the same time, it poses major risks, such as lung injury and reduced strength of the respiratory muscles. That this can also lead to negative long-term effects should come as no surprise.

But mechanical ventilation may also affect the brain, says technical physician Jonne Doorduin, who is affiliated with the ICU. He is part of the Radboudumc Talent Track and recently received a Vidi grant. With this prestigious funding from the Dutch Research Council (NWO), talented researchers can set up their own innovative research line. In a five‑year project, Doorduin aims to unravel the relationship between mechanical ventilation and brain activity.

There are several indications for this link, he explains. ‘We know that there is a very strong natural coupling between our breathing and brain functions. Many brain waves run in sync with your breathing.’ International research has shown, for example, that people who breathed through their nose during a memory test scored better than those who breathed through their mouth. Doorduin: ‘That’s because the nose registers the airflow, which is directly connected to the hippocampus. That brain region is crucial for learning and memory.’
 

Technical physician Jonne Doorduin.

Disruption of the natural rhythm

‘So what do we do in the ICU? Patients who require ventilation are intubated through the mouth. As a result, air no longer passes through the nose,’ Jonne Doorduin explains. Ventilation can also disturb the natural breathing rhythm, causing various brain regions to become dysregulated. ‘You can imagine that this is not without consequences. Large clinical studies also show a link between the duration of ventilation and acute and long-term cognitive outcomes.’ Each additional day on the ventilator increases the risk of acute confusion, known as delirium.

But Doorduin now wants to uncover how this works exactly. In an ongoing study, he uses EEG to measure how brain activity varies in healthy volunteers who breathe through the nose versus the mouth. For this research, Doorduin draws on his many years of experience in clinical neurophysiology. ‘I learned a great deal about the brain and EEG there. That’s why I can now make the connection with mechanical ventilation.’

By better understanding how brain activity and breathing are linked in healthy individuals, he can go on to study how ventilation disrupts this coupling in ICU patients. This may eventually lead to strategies to prevent such disturbances, such as providing additional nasal airflow for intubated patients.

Cognitive outcome

Highly technical research, yes, but with concrete outcomes. ‘If we ventilate ICU patients differently and this helps preserve their cognitive abilities, it can improve their quality of life after discharge,’ says Doorduin. His work aligns with the long-term follow-up outcome study on post‑ICU quality of life led by ICU colleagues Mark van den Boogaard and Marieke Zegers.

The brain is a relatively new focus area in ventilation research. Most other research is aimed at the lungs and respiratory muscles, especially the diaphragm. Doorduin also studies this. During his PhD research, also in the ICU, he explored new treatment strategies to prevent diaphragm weakening caused by ventilation.

In one of the new projects, Doorduin investigates the effect of PEEP, a ventilation setting that keeps the lungs open by applying constant pressure. ‘It’s very important, but a downside is that this pressure pushes the diaphragm downward, making it less efficient. PEEP affects the respiratory muscles and the neural drive of breathing; some patients even activate abdominal muscles to counteract it. In this study, we use extensive measurements to determine how to set PEEP optimally.’

A stronger diaphragm

Jonne Doorduin also highlights a Radboudumc research line that began in 2008 and has now led to a major Dutch study. The research focuses on levosimendan, a drug used for heart failure. In the lab, it also proved beneficial for diaphragm muscle cells. During his PhD, the technical physician tested the drug in healthy volunteers and showed it improved diaphragm strength. A small study in ICU patients followed, again with promising results. Now, a nationwide trial is underway, led by Doorduin and intensivist and department head Leo Heunks, with 250 patients difficult to be weaned from the ventilator. ‘It’s a double‑blind controlled trial, so half receive levosimendan and the other half a placebo. It’s wonderful that research that started here is now being continued nationwide’, Doorduin says.

Ultimately, all of Doorduins work comes down to one question: how can we minimize the harmful effects of mechanical ventilation? ‘We know that an ICU stay is tough on the body. So every day we can shorten that stay is a win. We can achieve this by optimizing ventilation, something that is often unavoidable in the ICU. I’m happy to contribute to that.’

Research: the long-term consequences of ICU admission

That an ICU stay has major impact is also evident from the Monitor-IC project led by Professor of Nursing Science Mark van den Boogaard and associate Professor Marieke Zegers. Since 2016, they charter the long-term effects of ICU admission on physical, mental, and cognitive functioning, as well as quality of life. They have the world’s largest database with patient data before, during, and up to two years after ICU admission, based on data from eight hospitals. One of the findings: more than half of patients develop new complaints a year after discharge, such as fatigue, anxiety, or muscle weakness, known as Post‑Intensive Care Syndrome (PICS). This concerns a large group. In 2024, about 70,000 people were admitted to an ICU in the Netherlands, and around 90% survived.

In Radboudumc, patients visit the ICU Aftercare Clinic, where they receive guidance and explanation about their situation. Van den Boogaard: ‘With the right information, patients return to their GP for follow‑up and regain control over their health.’

Professor in Nursing Science in Acute and Intensive Care Mark van den Boogaard.

This article appeared in Radbode #1, 2026.

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