Pulmonary Mechanics and Mortality in Mechanically Ventilated Patients Without Acute Respiratory Distress Syndrome: A Cohort Study

Brian M Fuller; David Page; Robert J Stephens; Brian W Roberts; Anne M Drewry; Enyo Ablordeppey; Nicholas M Mohr; Marin H Kollef

doi:10.1097/SHK.0000000000000977

Journal article

Pulmonary Mechanics and Mortality in Mechanically Ventilated Patients Without Acute Respiratory Distress Syndrome: A Cohort Study

Brian M Fuller, David Page, Robert J Stephens, Brian W Roberts, Anne M Drewry, Enyo Ablordeppey, Nicholas M Mohr and Marin H Kollef

Shock (Augusta, Ga.), Vol.49(3), pp.311-316

03/2018

DOI: 10.1097/SHK.0000000000000977

PMCID: PMC5809252

PMID: 28846571

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Abstract

Driving pressure has been proposed as a major determinant of outcome in patients with acute respiratory distress syndrome (ARDS), but there is little data examining the association between pulmonary mechanics, including driving pressure, and outcomes in mechanically ventilated patients without ARDS. Secondary analysis from 1,705 mechanically ventilated patients enrolled in a clinical study that examined outcomes associated with the use of early lung-protective mechanical ventilation. The primary outcome was mortality and the secondary outcome was the incidence of ARDS. Multivariable models were constructed to: define the association between pulmonary mechanics (driving pressure, plateau pressure, and compliance) and mortality; and evaluate if driving pressure contributed information beyond that provided by other pulmonary mechanics. The mortality rate for the entire cohort was 26.0%. Compared with survivors, non-survivors had significantly higher driving pressure [15.9 (5.4) vs. 14.9 (4.4), P = 0.005] and plateau pressure [21.4 (5.7) vs. 20.4 (4.6), P = 0.001]. Driving pressure was independently associated with mortality [adjusted OR, 1.04 (1.01-1.07)]. Models related to plateau pressure also revealed an independent association with mortality, with similar effect size and interval estimates as driving pressure. There were 152 patients who progressed to ARDS (8.9%). Along with driving pressure and plateau pressure, mechanical power [adjusted OR, 1.03 (1.00-1.06)] was also independently associated with ARDS development. In mechanically ventilated patients, driving pressure and plateau pressure are risk factors for mortality and ARDS, and provide similar information. Mechanical power is also a risk factor for ARDS.

Respiration, Artificial - mortality

Humans

Middle Aged

Adult

Female

Male

Aged

Respiratory Distress Syndrome, Adult - mortality

Respiratory Mechanics

Respiratory Distress Syndrome, Adult - therapy

Details

Title: Subtitle: Pulmonary Mechanics and Mortality in Mechanically Ventilated Patients Without Acute Respiratory Distress Syndrome: A Cohort Study
Creators: Brian M Fuller - Division of Critical Care, Departments of Emergency Medicine and Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
David Page - Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
Robert J Stephens - Washington University School of Medicine in St. Louis, St. Louis, Missouri
Brian W Roberts - Department of Emergency Medicine, Cooper University Hospital, Camden, New Jersey
Anne M Drewry - Division of Critical Care Medicine, Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
Enyo Ablordeppey - Division of Critical Care, Departments of Emergency Medicine and Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
Nicholas M Mohr - Division of Critical Care, Departments of Emergency Medicine and Anesthesiology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
Marin H Kollef - Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
Resource Type: Journal article
Publication Details: Shock (Augusta, Ga.), Vol.49(3), pp.311-316
DOI: 10.1097/SHK.0000000000000977
PMID: 28846571
PMCID: PMC5809252
NLM abbreviation: Shock
ISSN: 1073-2322
eISSN: 1540-0514
Publisher: United States
Grant note: KL2 TR002346 / NCATS NIH HHS TL1 TR002344 / NCATS NIH HHS L30 HL115663 / NHLBI NIH HHS KL2 TR000450 / NCATS NIH HHS UL1 TR002345 / NCATS NIH HHS TL1 TR000449 / NCATS NIH HHS UL1 TR000448 / NCATS NIH HHS K23 HL126979 / NHLBI NIH HHS
Language: English
Date published: 03/2018
Academic Unit: Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
Record Identifier: 9984024407602771

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