Association between hospital mortality and inspiratory airway pressures in mechanically ventilated patients without acute respiratory distress syndrome: a prospective cohort study
Abstract Background Higher inspiratory airway pressures are associated with worse outcomes in mechanically ventilated patients with the acute respiratory distress syndrome (ARDS). This relationship, however, has not been well investigated in patients without ARDS. We hypothesized that higher driving...
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| Format: | Article |
| Language: | English |
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BMC
2019-11-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13054-019-2635-y |
| _version_ | 1819159058482987008 |
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| author | Sarina K. Sahetya Christopher Mallow Jonathan E. Sevransky Greg S. Martin Timothy D. Girard Roy G. Brower William Checkley Society of Critical Care Medicine Discovery Network Critical Illness Outcomes Study Investigators |
| author_facet | Sarina K. Sahetya Christopher Mallow Jonathan E. Sevransky Greg S. Martin Timothy D. Girard Roy G. Brower William Checkley Society of Critical Care Medicine Discovery Network Critical Illness Outcomes Study Investigators |
| author_sort | Sarina K. Sahetya |
| collection | DOAJ |
| description | Abstract Background Higher inspiratory airway pressures are associated with worse outcomes in mechanically ventilated patients with the acute respiratory distress syndrome (ARDS). This relationship, however, has not been well investigated in patients without ARDS. We hypothesized that higher driving pressures (ΔP) and plateau pressures (Pplat) are associated with worse patient-centered outcomes in mechanically ventilated patients without ARDS as well as those with ARDS. Methods Using data collected during a prospective, observational cohort study of 6179 critically ill participants enrolled in 59 ICUs across the USA, we used multivariable logistic regression to determine whether ΔP and Pplat at enrollment were associated with hospital mortality among 1132 mechanically ventilated participants. We stratified analyses by ARDS status. Results Participants without ARDS (n = 822) had lower average severity of illness scores and lower hospital mortality (27.3% vs. 38.7%; p < 0.001) than those with ARDS (n = 310). Average Pplat (20.6 vs. 23.9 cm H2O; p < 0.001), ΔP (14.3 vs. 16.0 cm H2O; p < 0.001), and positive end-expiratory pressure (6.3 vs. 7.9 cm H2O; p < 0.001) were lower in participants without ARDS, whereas average tidal volumes (7.2 vs. 6.8 mL/kg PBW; p < 0.001) were higher. Among those without ARDS, higher ΔP (adjusted OR = 1.36 per 7 cm H2O, 95% CI 1.14–1.62) and Pplat (adjusted OR = 1.42 per 8 cm H2O, 95% CI 1.17–1.73) were associated with higher mortality. We found similar relationships with mortality among those participants with ARDS. Conclusions Higher ΔP and Pplat are associated with increased mortality for participants without ARDS. ΔP may be a viable target for lung-protective ventilation in all mechanically ventilated patients. |
| first_indexed | 2024-12-22T16:34:31Z |
| format | Article |
| id | doaj.art-77f37dec30144631bfb4756456ec7503 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-22T16:34:31Z |
| publishDate | 2019-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-77f37dec30144631bfb4756456ec75032022-12-21T18:19:59ZengBMCCritical Care1364-85352019-11-0123111010.1186/s13054-019-2635-yAssociation between hospital mortality and inspiratory airway pressures in mechanically ventilated patients without acute respiratory distress syndrome: a prospective cohort studySarina K. Sahetya0Christopher Mallow1Jonathan E. Sevransky2Greg S. Martin3Timothy D. Girard4Roy G. Brower5William Checkley6Society of Critical Care Medicine Discovery Network Critical Illness Outcomes Study InvestigatorsDivision of Pulmonary and Critical Care, Johns Hopkins UniversityDivision of Pulmonary and Critical Care, Johns Hopkins UniversityDivision of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory UniversityDivision of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory UniversityClinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of MedicineDivision of Pulmonary and Critical Care, Johns Hopkins UniversityDivision of Pulmonary and Critical Care, Johns Hopkins UniversityAbstract Background Higher inspiratory airway pressures are associated with worse outcomes in mechanically ventilated patients with the acute respiratory distress syndrome (ARDS). This relationship, however, has not been well investigated in patients without ARDS. We hypothesized that higher driving pressures (ΔP) and plateau pressures (Pplat) are associated with worse patient-centered outcomes in mechanically ventilated patients without ARDS as well as those with ARDS. Methods Using data collected during a prospective, observational cohort study of 6179 critically ill participants enrolled in 59 ICUs across the USA, we used multivariable logistic regression to determine whether ΔP and Pplat at enrollment were associated with hospital mortality among 1132 mechanically ventilated participants. We stratified analyses by ARDS status. Results Participants without ARDS (n = 822) had lower average severity of illness scores and lower hospital mortality (27.3% vs. 38.7%; p < 0.001) than those with ARDS (n = 310). Average Pplat (20.6 vs. 23.9 cm H2O; p < 0.001), ΔP (14.3 vs. 16.0 cm H2O; p < 0.001), and positive end-expiratory pressure (6.3 vs. 7.9 cm H2O; p < 0.001) were lower in participants without ARDS, whereas average tidal volumes (7.2 vs. 6.8 mL/kg PBW; p < 0.001) were higher. Among those without ARDS, higher ΔP (adjusted OR = 1.36 per 7 cm H2O, 95% CI 1.14–1.62) and Pplat (adjusted OR = 1.42 per 8 cm H2O, 95% CI 1.17–1.73) were associated with higher mortality. We found similar relationships with mortality among those participants with ARDS. Conclusions Higher ΔP and Pplat are associated with increased mortality for participants without ARDS. ΔP may be a viable target for lung-protective ventilation in all mechanically ventilated patients.http://link.springer.com/article/10.1186/s13054-019-2635-yDriving pressureMechanical ventilationAcute respiratory failureARDS |
| spellingShingle | Sarina K. Sahetya Christopher Mallow Jonathan E. Sevransky Greg S. Martin Timothy D. Girard Roy G. Brower William Checkley Society of Critical Care Medicine Discovery Network Critical Illness Outcomes Study Investigators Association between hospital mortality and inspiratory airway pressures in mechanically ventilated patients without acute respiratory distress syndrome: a prospective cohort study Critical Care Driving pressure Mechanical ventilation Acute respiratory failure ARDS |
| title | Association between hospital mortality and inspiratory airway pressures in mechanically ventilated patients without acute respiratory distress syndrome: a prospective cohort study |
| title_full | Association between hospital mortality and inspiratory airway pressures in mechanically ventilated patients without acute respiratory distress syndrome: a prospective cohort study |
| title_fullStr | Association between hospital mortality and inspiratory airway pressures in mechanically ventilated patients without acute respiratory distress syndrome: a prospective cohort study |
| title_full_unstemmed | Association between hospital mortality and inspiratory airway pressures in mechanically ventilated patients without acute respiratory distress syndrome: a prospective cohort study |
| title_short | Association between hospital mortality and inspiratory airway pressures in mechanically ventilated patients without acute respiratory distress syndrome: a prospective cohort study |
| title_sort | association between hospital mortality and inspiratory airway pressures in mechanically ventilated patients without acute respiratory distress syndrome a prospective cohort study |
| topic | Driving pressure Mechanical ventilation Acute respiratory failure ARDS |
| url | http://link.springer.com/article/10.1186/s13054-019-2635-y |
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