Driving Pressure Is a Risk Factor for ARDS in Mechanically Ventilated Subjects Without ARDS.
BACKGROUND: Driving pressure (DP) has been described as a risk factor for mortality in patients with ARDS. However, the role of DP in the outcome of patients without ARDS and on mechanical ventilation has received less attention. Our objective was to evaluate the association between DP on the first...
| Published in: | Respiratory Care Vol. 66; no. 10; pp. 1505 - 1514 |
|---|---|
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
| Format: | CEU research tables/charts Journal Article |
| Published: |
Mary Ann Liebert, Inc.
Oct2021
|
| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=152579683&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 152579683 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Oct2021 vid: 66 iid: 10 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 152579683 152579683 152579683 10.4187/respcare.08587 152579683 ppf: 1505 ppct: 9 formats: fmt: @attributes: type: P tig: atl: Driving Pressure Is a Risk Factor for ARDS in Mechanically Ventilated Subjects Without ARDS. aug: au: Roca, Oriol Peñuelas, Oscar Muriel, Alfonso García-de-Acilu, Marina Laborda, César Sacanell, Judit Riera, Jordi Raymondos, Konstantinos Bin Du Thille, Arnaud W. Ríos, Fernando González, Marco del-Sorbo, Lorenzo Marín, Maria del Carmen Soares, Marco Antonio Valle Pinheiro, Bruno Nin, Nicolas Maggiore, Salvatore M. Bersten, Andrew Amin, Pravin affil: Servei de Medicina Intensiva, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain sug: subj: Respiratory Distress Syndrome, Acute Risk Factors Respiration, Artificial Ventilator Patients Risk Assessment Positive End-Expiratory Pressure Adverse Effects Airway Pressure Ventilator-Induced Lung Injury Education, Continuing (Credit) Human Post Hoc Analysis Multicenter Studies Prospective Studies Nonexperimental Studies Logistic Regression Odds Ratio Confidence Intervals T-Tests Mann-Whitney U Test Chi Square Test Fisher's Exact Test Adult Middle Age Aged Male Female Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Male Female ab: BACKGROUND: Driving pressure (DP) has been described as a risk factor for mortality in patients with ARDS. However, the role of DP in the outcome of patients without ARDS and on mechanical ventilation has received less attention. Our objective was to evaluate the association between DP on the first day of mechanical ventilation with the development of ARDS. METHODS: This was a post hoc analysis of a multicenter, prospective, observational, international study that included subjects who were on mechanical ventilation for > 12 h. Our objective was to evaluate the association between DP on the first day of mechanical ventilation with the development of ARDS. To assess the effect of DP, a logistic regression analysis was performed when adjusting for other potential risk factors. Validation of the results obtained was performed by using a bootstrap method and by repeating the same analyses at day 2. RESULTS: A total of 1,575 subjects were included, of whom 65 (4.1%) developed ARDS. The DP was independently associated with ARDS (odds ratio [OR] 1.12, 95% CI 1.07-1.18 for each cm H2O of DP increase, P < .001). The same results were observed at day 2 (OR 1.14, 95% CI 1.07-1.21; P < .001) and after bootstrap validation (OR 1.13, 95% CI 1.04-1.22; P < .001). When taking the prevalence of ARDS in the lowest quartile of DP (≤9 cm H2O) as a reference, the subjects with DP > 12-15 cm H2O and those with DP > 15 cm H2O presented a higher probability of ARDS (OR 3.65, 95% CI 1.32-10.04 [P 5 .01] and OR 7.31, 95% CI, 2.89-18.50 [P < .001], respectively). CONCLUSIONS: In the subjects without ARDS, a higher level of DP on the first day of mechanical ventilation was associated with later development of ARDS. (ClinicalTrials.gov registration NCT02731898.) pubtype: Academic Journal doctype: CEU research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|