Journal article
Mechanical ventilation in patients with cardiogenic pulmonary edema: a sub-analysis of the LUNG SAFE study
Journal of intensive care, Vol.10, 55
12/22/2022
DOI: 10.1186/s40560-022-00648-x
PMCID: PMC9791731
PMID: 36567347
Abstract
Background
Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality.
Methods
Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model.
Results
From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59–78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57–77] vs 74 [64–80] years, p < 0.001) and had lower driving (12 [8–16] vs 15 [11–17] cmH2O, p < 0.001), plateau (20 [15–23] vs 22 [19–26] cmH2O, p < 0.001) and peak (21 [17–27] vs 26 [20–32] cmH2O, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60–1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16–2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06–1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52–0.93], p = 0.015) were related to survival.
Conclusions
Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury.
Details
- Title: Subtitle
- Mechanical ventilation in patients with cardiogenic pulmonary edema: a sub-analysis of the LUNG SAFE study
- Creators
- Laura Amado-Rodríguez - Instituto de Investigación Sanitaria del Principado de AsturiasRaquel Rodríguez‑Garcia - Instituto de Investigación Sanitaria del Principado de AsturiasGiacomo Bellani - University of Milano-BicoccaTai Pham - Bicêtre HospitalEddy Fan - University of TorontoFabiana Madotto - University of Milano-BicoccaJohn G Laffey - Ollscoil na Gaillimhe – University of GalwayGuillermo M Albaiceta - Universidad de OviedoLUNG SAFE investigators
- Contributors
- Hiroyuki Suzuki (Contributor) - University of Iowa, Infectious DiseasesNicholas M Mohr (Contributor) - University of Iowa, Anesthesia
- Resource Type
- Journal article
- Publication Details
- Journal of intensive care, Vol.10, 55
- DOI
- 10.1186/s40560-022-00648-x
- PMID
- 36567347
- PMCID
- PMC9791731
- NLM abbreviation
- J Intensive Care
- ISSN
- 2052-0492
- Publisher
- BioMed Central Ltd
- Grant note
- name: Centro de Investigación Biomédica en Red, award: CB17/06/00021; DOI: 10.13039/501100008430, name: Fundación para el Fomento en Asturias de la Investigación Científica Aplicada y la Tecnología, award: AYUD2021/52014; DOI: 10.13039/501100004587, name: Instituto de Salud Carlos III, award: CM20/00083
- Language
- English
- Date published
- 12/22/2022
- Academic Unit
- Infectious Diseases; Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9984366655102771
Metrics
9 Record Views