A Retrospective Analysis of the Effects of Time on Compliance and Driving Pressures in ARDS.
BACKGROUND: The evolution of compliance and driving pressure in ARDS and the effects of time spent on noninvasive respiratory support prior to intubation have not been well studied. We conducted this study to assess the effect of the duration of noninvasive respiratory support prior to intubation (i...
| Publicado en: | Respiratory Care Vol. 68; no. 1; pp. 52 - 60 |
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| Autores principales: | , , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Jan2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=160923588&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 160923588 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Jan2023 vid: 68 iid: 1 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 160923588 160923588 160923588 10.4187/respcare.10080 160923588 ppf: 52 ppct: 8 formats: fmt: @attributes: type: P tig: atl: A Retrospective Analysis of the Effects of Time on Compliance and Driving Pressures in ARDS. aug: au: Jagan, Nikhil Morrow, Lee E. Walters, Ryan W. Plambeck, Robert W. Ng, Ian Chovatiya, Jasmin J. Macaraeg, Jeffrey C. Kalian, Karson F. Wittenberg, Zachariah L. Pruett, William M. Knedler, Jonathan Klein, Lauren P. Kasinath, Pooja Dyer, Emily D. Bergh, Adam A. Malesker, Mark A. affil: Creighton University School of Medicine, Division of Pulmonary and Critical Care, Omaha, Nebraska sug: subj: Time Factors Respiratory Distress Syndrome, Acute Therapy Noninvasive Procedures Methods Respiratory Therapy Methods Treatment Duration Treatment Outcomes Evaluation COVID-19 Complications Respiration, Artificial Tidal Volume Evaluation Airway Pressure Evaluation Lung Compliance Evaluation Human Male Female Adult Middle Age Aged Retrospective Design Prospective Studies Nasal Cannula Combined Modality Therapy Academic Medical Centers Magnet Hospitals Hospitals, Rural Suburban Areas Community Health Centers Ventilator Patients Inpatients Nebraska Positive End-Expiratory Pressure Descriptive Statistics Comparative Studies Mann-Whitney U Test Unpaired T-Tests Questionnaires Kaplan-Meier Estimator Cox Proportional Hazards Model Log-Rank Test Data Analysis Software Respiratory Distress Syndrome, Acute Prognosis Invasive Procedures Confidence Intervals Hospital Mortality Length of Stay Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Male Female ab: BACKGROUND: The evolution of compliance and driving pressure in ARDS and the effects of time spent on noninvasive respiratory support prior to intubation have not been well studied. We conducted this study to assess the effect of the duration of noninvasive respiratory support prior to intubation (ie, noninvasive ventilation [NIV], high-flow nasal cannula [HFNC], or a combination of NIV and HFNC) on static compliance and driving pressure and retrospectively describe its trajectory over time for COVID-19 and non--COVID-19 ARDS while on mechanical ventilation. METHODS: This is a retrospective analysis of prospectively collected data from one university-affiliated academic medical center, one rural magnet hospital, and 3 suburban community facilities. A total of 589 subjects were included: 55 COVID-19 positive, 137 culture positive, and 397 culture-negative subjects. Static compliance and driving pressure were calculated at each 8-h subject-ventilator assessment. RESULTS: Days of pre-intubation noninvasive respiratory support were associated with worse compliance and driving pressure but did not moderate any trajectory. COVID-19--positive subjects showed non-statistically significant worsening compliance by 0.08 units per subject-ventilator assessment (P 5 .24), whereas COVID-19--negative subjects who were either culture positive or negative showed statistically significant improvement (0.12 and 0.18, respectively; both P < .05); a statistically similar but inverse pattern was observed for driving pressure. CONCLUSIONS: In contrast to non--COVID-19 ARDS, COVID-19 ARDS was associated with a more ominous trajectory with no improvement in static compliance or driving pressures. Though there was no association between days of pre-intubation noninvasive respiratory support and mortality, its use was associated with worse overall compliance and driving pressure. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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