Driving pressure-guided ventilation versus protective lung ventilation in ARDS patients: A prospective randomized controlled study

ABSTRACTBackground: Secondary analyses of randomized controlled trials found that driving pressure (DP) ≤ 14 cm H2O may be associated with improved clinical outcomes in acute respiratory distress syndrome (ARDS) patients. Therefore, the aim of this study was to evaluate the effect of DP-guided venti...

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Main Authors: Khaled M. Hamama, Sameh M. Fathy, Reda S. AbdAlrahman, Salah El-Din I. Alsherif, Sameh Abdelkhalik Ahmed
Format: Article
Language:English
Published: Taylor & Francis Group 2021-01-01
Series:Egyptian Journal of Anaesthesia
Subjects:
Online Access:https://www.tandfonline.com/doi/10.1080/11101849.2021.1930401
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author Khaled M. Hamama
Sameh M. Fathy
Reda S. AbdAlrahman
Salah El-Din I. Alsherif
Sameh Abdelkhalik Ahmed
author_facet Khaled M. Hamama
Sameh M. Fathy
Reda S. AbdAlrahman
Salah El-Din I. Alsherif
Sameh Abdelkhalik Ahmed
author_sort Khaled M. Hamama
collection DOAJ
description ABSTRACTBackground: Secondary analyses of randomized controlled trials found that driving pressure (DP) ≤ 14 cm H2O may be associated with improved clinical outcomes in acute respiratory distress syndrome (ARDS) patients. Therefore, the aim of this study was to evaluate the effect of DP-guided ventilation compared to conventional protective lung ventilation (PLV) on clinical outcomes in ARDS patients.Methods: In this prospective, controlled trial, 110 patients with ARDS were randomly assigned according to ventilatory strategy into conventional PLV group and DP-guided ventilation group (by maintaining DP value ≤ 14 cm H2O). Clinical outcomes were incidence of mortality at 28th day (primary outcome), PaO2/FiO2, static compliance (Cstat), organ(s) dysfunction, mechanical ventilation (MV) duration, and length of ICU stay.Results: Incidence of mortality at 28th day was reduced in DP-guided ventilation group compared to PLV group (20% vs. 5.45%); the hazard ratio was 0.26)95% CI: 0.09 to 0.73). The PaO2/FiO2, C stat and MV-free days were higher in in DP-guided ventilation group compared to PLV group. Organ dysfunction, duration of MV and length of ICU stay were significantly lower DP-guided ventilation group compared to PLV group.Conclusions: In patients with ARDS, DP-guided ventilation showed improved survival, Cstat and oxygenation and lower incidence of organ dysfunction, duration of MV and length of ICU stay compared to PLV.
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spelling doaj.art-310943abab044b6082e4e1f9dd7749e32023-09-15T13:38:33ZengTaylor & Francis GroupEgyptian Journal of Anaesthesia1110-18492021-01-0137126126710.1080/11101849.2021.1930401Driving pressure-guided ventilation versus protective lung ventilation in ARDS patients: A prospective randomized controlled studyKhaled M. Hamama0Sameh M. Fathy1Reda S. AbdAlrahman2Salah El-Din I. Alsherif3Sameh Abdelkhalik Ahmed4Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Tanta University, Tanta, EgyptAnesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Tanta University, Tanta, EgyptAnesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Tanta University, Tanta, EgyptAnesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Tanta University, Tanta, EgyptAnesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Tanta University, Tanta, EgyptABSTRACTBackground: Secondary analyses of randomized controlled trials found that driving pressure (DP) ≤ 14 cm H2O may be associated with improved clinical outcomes in acute respiratory distress syndrome (ARDS) patients. Therefore, the aim of this study was to evaluate the effect of DP-guided ventilation compared to conventional protective lung ventilation (PLV) on clinical outcomes in ARDS patients.Methods: In this prospective, controlled trial, 110 patients with ARDS were randomly assigned according to ventilatory strategy into conventional PLV group and DP-guided ventilation group (by maintaining DP value ≤ 14 cm H2O). Clinical outcomes were incidence of mortality at 28th day (primary outcome), PaO2/FiO2, static compliance (Cstat), organ(s) dysfunction, mechanical ventilation (MV) duration, and length of ICU stay.Results: Incidence of mortality at 28th day was reduced in DP-guided ventilation group compared to PLV group (20% vs. 5.45%); the hazard ratio was 0.26)95% CI: 0.09 to 0.73). The PaO2/FiO2, C stat and MV-free days were higher in in DP-guided ventilation group compared to PLV group. Organ dysfunction, duration of MV and length of ICU stay were significantly lower DP-guided ventilation group compared to PLV group.Conclusions: In patients with ARDS, DP-guided ventilation showed improved survival, Cstat and oxygenation and lower incidence of organ dysfunction, duration of MV and length of ICU stay compared to PLV.https://www.tandfonline.com/doi/10.1080/11101849.2021.1930401Driving pressure guided ventilationprotective lung ventilationARDS
spellingShingle Khaled M. Hamama
Sameh M. Fathy
Reda S. AbdAlrahman
Salah El-Din I. Alsherif
Sameh Abdelkhalik Ahmed
Driving pressure-guided ventilation versus protective lung ventilation in ARDS patients: A prospective randomized controlled study
Egyptian Journal of Anaesthesia
Driving pressure guided ventilation
protective lung ventilation
ARDS
title Driving pressure-guided ventilation versus protective lung ventilation in ARDS patients: A prospective randomized controlled study
title_full Driving pressure-guided ventilation versus protective lung ventilation in ARDS patients: A prospective randomized controlled study
title_fullStr Driving pressure-guided ventilation versus protective lung ventilation in ARDS patients: A prospective randomized controlled study
title_full_unstemmed Driving pressure-guided ventilation versus protective lung ventilation in ARDS patients: A prospective randomized controlled study
title_short Driving pressure-guided ventilation versus protective lung ventilation in ARDS patients: A prospective randomized controlled study
title_sort driving pressure guided ventilation versus protective lung ventilation in ards patients a prospective randomized controlled study
topic Driving pressure guided ventilation
protective lung ventilation
ARDS
url https://www.tandfonline.com/doi/10.1080/11101849.2021.1930401
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