Elevated Driving Pressure and Elastance Does Not Increase In-Hospital Mortality Among Obese and Severely Obese Patients With Ventilator Dependent Respiratory Failure
Importance:. Existing recommendations for mechanical ventilation are based on studies that under-sampled or excluded obese and severely obese individuals. Objective:. To determine if driving pressure (DP) and total respiratory system elastance (Ers) differ among normal/overweight (body mass index [B...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2022-12-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000000811 |
| _version_ | 1797976910424178688 |
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| author | Charles Terry, MD, MSCR Daniel Brinton, PhD Annie N. Simpson, PhD Katie Kirchoff, MS D. Clark Files, MD George Carter, MD Dee W. Ford, MD, MSCR Andrew J. Goodwin, MD, MSCR |
| author_facet | Charles Terry, MD, MSCR Daniel Brinton, PhD Annie N. Simpson, PhD Katie Kirchoff, MS D. Clark Files, MD George Carter, MD Dee W. Ford, MD, MSCR Andrew J. Goodwin, MD, MSCR |
| author_sort | Charles Terry, MD, MSCR |
| collection | DOAJ |
| description | Importance:. Existing recommendations for mechanical ventilation are based on studies that under-sampled or excluded obese and severely obese individuals.
Objective:. To determine if driving pressure (DP) and total respiratory system elastance (Ers) differ among normal/overweight (body mass index [BMI] < 30 kg/m2), obese, and severely obese ventilator-dependent respiratory failure (VDRF) patients and if there any associations with clinical outcomes.
Design, Setting, and Participants:. Retrospective observational cohort study during 2016–2018 at two tertiary care academic medical centers using electronic health record data from the first 2 full days of mechanical ventilation. The cohort was stratified by BMI classes to measure median DP, time-weighted mean tidal volume, plateau pressure, and Ers for each BMI class.
Setting and Participants:. Mechanically ventilated patients in medical and surgical ICUs.
Main Outcomes and Measures:. Primary outcome and effect measures included relative risk of in-hospital mortality, ventilator-free days, ICU length of stay, and hospital length of stay with multivariable adjustment.
Results:. The cohort included 3,204 patients with 976 (30.4%) and 382 (11.9%) obese and severely obese patients, respectively. Severe obesity was associated with a DP greater than or equal to 15 cm H2O (relative risk [RR], 1.51 [95% CI, 1.26–1.82]) and Ers greater than or equal to 2 cm H2O/(mL/kg) (RR, 1.31 [95% CI, 1.14–1.49]). Despite elevated DP and Ers, there were no differences in in-hospital mortality, ventilator-free days, or ICU length of stay among all three groups.
Conclusions and Relevance:. Despite higher DP and ERS among obese and severely obese VDRF patients, there were no differences in in-hospital mortality or duration of mechanical ventilation, suggesting that DP has less prognostic value in obese and severely obese VDRF patients. |
| first_indexed | 2024-04-11T04:58:32Z |
| format | Article |
| id | doaj.art-33f1406485034064a28c4b46ec7bd672 |
| institution | Directory Open Access Journal |
| issn | 2639-8028 |
| language | English |
| last_indexed | 2024-04-11T04:58:32Z |
| publishDate | 2022-12-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj.art-33f1406485034064a28c4b46ec7bd6722022-12-26T06:01:07ZengWolters KluwerCritical Care Explorations2639-80282022-12-01412e081110.1097/CCE.0000000000000811202212000-00014Elevated Driving Pressure and Elastance Does Not Increase In-Hospital Mortality Among Obese and Severely Obese Patients With Ventilator Dependent Respiratory FailureCharles Terry, MD, MSCR0Daniel Brinton, PhD1Annie N. Simpson, PhD2Katie Kirchoff, MS3D. Clark Files, MD4George Carter, MD5Dee W. Ford, MD, MSCR6Andrew J. Goodwin, MD, MSCR71 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC.2 Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, SC.2 Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, SC.3 Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, SC.4 Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC.1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC.1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC.1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC.Importance:. Existing recommendations for mechanical ventilation are based on studies that under-sampled or excluded obese and severely obese individuals. Objective:. To determine if driving pressure (DP) and total respiratory system elastance (Ers) differ among normal/overweight (body mass index [BMI] < 30 kg/m2), obese, and severely obese ventilator-dependent respiratory failure (VDRF) patients and if there any associations with clinical outcomes. Design, Setting, and Participants:. Retrospective observational cohort study during 2016–2018 at two tertiary care academic medical centers using electronic health record data from the first 2 full days of mechanical ventilation. The cohort was stratified by BMI classes to measure median DP, time-weighted mean tidal volume, plateau pressure, and Ers for each BMI class. Setting and Participants:. Mechanically ventilated patients in medical and surgical ICUs. Main Outcomes and Measures:. Primary outcome and effect measures included relative risk of in-hospital mortality, ventilator-free days, ICU length of stay, and hospital length of stay with multivariable adjustment. Results:. The cohort included 3,204 patients with 976 (30.4%) and 382 (11.9%) obese and severely obese patients, respectively. Severe obesity was associated with a DP greater than or equal to 15 cm H2O (relative risk [RR], 1.51 [95% CI, 1.26–1.82]) and Ers greater than or equal to 2 cm H2O/(mL/kg) (RR, 1.31 [95% CI, 1.14–1.49]). Despite elevated DP and Ers, there were no differences in in-hospital mortality, ventilator-free days, or ICU length of stay among all three groups. Conclusions and Relevance:. Despite higher DP and ERS among obese and severely obese VDRF patients, there were no differences in in-hospital mortality or duration of mechanical ventilation, suggesting that DP has less prognostic value in obese and severely obese VDRF patients.http://journals.lww.com/10.1097/CCE.0000000000000811 |
| spellingShingle | Charles Terry, MD, MSCR Daniel Brinton, PhD Annie N. Simpson, PhD Katie Kirchoff, MS D. Clark Files, MD George Carter, MD Dee W. Ford, MD, MSCR Andrew J. Goodwin, MD, MSCR Elevated Driving Pressure and Elastance Does Not Increase In-Hospital Mortality Among Obese and Severely Obese Patients With Ventilator Dependent Respiratory Failure Critical Care Explorations |
| title | Elevated Driving Pressure and Elastance Does Not Increase In-Hospital Mortality Among Obese and Severely Obese Patients With Ventilator Dependent Respiratory Failure |
| title_full | Elevated Driving Pressure and Elastance Does Not Increase In-Hospital Mortality Among Obese and Severely Obese Patients With Ventilator Dependent Respiratory Failure |
| title_fullStr | Elevated Driving Pressure and Elastance Does Not Increase In-Hospital Mortality Among Obese and Severely Obese Patients With Ventilator Dependent Respiratory Failure |
| title_full_unstemmed | Elevated Driving Pressure and Elastance Does Not Increase In-Hospital Mortality Among Obese and Severely Obese Patients With Ventilator Dependent Respiratory Failure |
| title_short | Elevated Driving Pressure and Elastance Does Not Increase In-Hospital Mortality Among Obese and Severely Obese Patients With Ventilator Dependent Respiratory Failure |
| title_sort | elevated driving pressure and elastance does not increase in hospital mortality among obese and severely obese patients with ventilator dependent respiratory failure |
| url | http://journals.lww.com/10.1097/CCE.0000000000000811 |
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