Driving Pressure, Elastance, and Outcomes in a Real-World Setting: A Bi-Center Analysis of Electronic Health Record Data
OBJECTIVES:. Emerging evidence suggests the potential importance of inspiratory driving pressure (DP) and respiratory system elastance (ERS) on outcomes among patients with the acute respiratory distress syndrome. Their association with outcomes among heterogeneous populations outside of a controlle...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2023-03-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000000877 |
| _version_ | 1797859653700288512 |
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| author | Andrew J. Goodwin, MD, MSCR Daniel L. Brinton, PhD Charles Terry, MD, MSCR George Carter, MD D. Clark Files, MD Katie Kirchoff, MS Dee W. Ford, MD, MSCR Annie N. Simpson, PhD |
| author_facet | Andrew J. Goodwin, MD, MSCR Daniel L. Brinton, PhD Charles Terry, MD, MSCR George Carter, MD D. Clark Files, MD Katie Kirchoff, MS Dee W. Ford, MD, MSCR Annie N. Simpson, PhD |
| author_sort | Andrew J. Goodwin, MD, MSCR |
| collection | DOAJ |
| description | OBJECTIVES:. Emerging evidence suggests the potential importance of inspiratory driving pressure (DP) and respiratory system elastance (ERS) on outcomes among patients with the acute respiratory distress syndrome. Their association with outcomes among heterogeneous populations outside of a controlled clinical trial is underexplored. We used electronic health record (EHR) data to characterize the associations of DP and ERS with clinical outcomes in a real-world heterogenous population.
DESIGN:. Observational cohort study.
SETTING:. Fourteen ICUs in two quaternary academic medical centers.
PATIENTS:. Adult patients who received mechanical ventilation for more than 48 hours and less than 30 days.
INTERVENTIONS:. None.
MEASUREMENTS AND MAIN RESULTS:. EHR data from 4,233 ventilated patients from 2016 to 2018 were extracted, harmonized, and merged. A minority of the analytic cohort (37%) experienced a Pao2/Fio2 of less than 300. A time-weighted mean exposure was calculated for ventilatory variables including tidal volume (VT), plateau pressures (PPLAT), DP, and ERS. Lung-protective ventilation adherence was high (94% with VT < 8.5 mL/kg, time-weighted mean VT = 6. 8 mL/kg, 88% with PPLAT ≤ 30 cm H2O). Although time-weighted mean DP (12.2 cm H2O) and ERS (1.9 cm H2O/[mL/kg]) were modest, 29% and 39% of the cohort experienced a DP greater than 15 cm H2O or an ERS greater than 2 cm H2O/(mL/kg), respectively. Regression modeling with adjustment for relevant covariates determined that exposure to time-weighted mean DP (> 15 cm H2O) was associated with increased adjusted risk of mortality and reduced adjusted ventilator-free days independent of adherence to lung-protective ventilation. Similarly, exposure to time-weighted mean ERS greater than 2 cm H2O/(mL/kg) was associated with increased adjusted risk of mortality.
CONCLUSIONS:. Elevated DP and ERS are associated with increased risk of mortality among ventilated patients independent of severity of illness or oxygenation impairment. EHR data can enable assessment of time-weighted ventilator variables and their association with clinical outcomes in a multicenter real-world setting. |
| first_indexed | 2024-04-09T21:34:12Z |
| format | Article |
| id | doaj.art-df34f72b2c7e4d9d9e99611b8ff80be8 |
| institution | Directory Open Access Journal |
| issn | 2639-8028 |
| language | English |
| last_indexed | 2024-04-09T21:34:12Z |
| publishDate | 2023-03-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj.art-df34f72b2c7e4d9d9e99611b8ff80be82023-03-27T06:46:51ZengWolters KluwerCritical Care Explorations2639-80282023-03-0153e087710.1097/CCE.0000000000000877202303000-00001Driving Pressure, Elastance, and Outcomes in a Real-World Setting: A Bi-Center Analysis of Electronic Health Record DataAndrew J. Goodwin, MD, MSCR0Daniel L. Brinton, PhD1Charles Terry, MD, MSCR2George Carter, MD3D. Clark Files, MD4Katie Kirchoff, MS5Dee W. Ford, MD, MSCR6Annie N. Simpson, PhD71 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.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.3 Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston Salem, NC.4 Biomedical Informatics Center, College 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.2 Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, SC.OBJECTIVES:. Emerging evidence suggests the potential importance of inspiratory driving pressure (DP) and respiratory system elastance (ERS) on outcomes among patients with the acute respiratory distress syndrome. Their association with outcomes among heterogeneous populations outside of a controlled clinical trial is underexplored. We used electronic health record (EHR) data to characterize the associations of DP and ERS with clinical outcomes in a real-world heterogenous population. DESIGN:. Observational cohort study. SETTING:. Fourteen ICUs in two quaternary academic medical centers. PATIENTS:. Adult patients who received mechanical ventilation for more than 48 hours and less than 30 days. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. EHR data from 4,233 ventilated patients from 2016 to 2018 were extracted, harmonized, and merged. A minority of the analytic cohort (37%) experienced a Pao2/Fio2 of less than 300. A time-weighted mean exposure was calculated for ventilatory variables including tidal volume (VT), plateau pressures (PPLAT), DP, and ERS. Lung-protective ventilation adherence was high (94% with VT < 8.5 mL/kg, time-weighted mean VT = 6. 8 mL/kg, 88% with PPLAT ≤ 30 cm H2O). Although time-weighted mean DP (12.2 cm H2O) and ERS (1.9 cm H2O/[mL/kg]) were modest, 29% and 39% of the cohort experienced a DP greater than 15 cm H2O or an ERS greater than 2 cm H2O/(mL/kg), respectively. Regression modeling with adjustment for relevant covariates determined that exposure to time-weighted mean DP (> 15 cm H2O) was associated with increased adjusted risk of mortality and reduced adjusted ventilator-free days independent of adherence to lung-protective ventilation. Similarly, exposure to time-weighted mean ERS greater than 2 cm H2O/(mL/kg) was associated with increased adjusted risk of mortality. CONCLUSIONS:. Elevated DP and ERS are associated with increased risk of mortality among ventilated patients independent of severity of illness or oxygenation impairment. EHR data can enable assessment of time-weighted ventilator variables and their association with clinical outcomes in a multicenter real-world setting.http://journals.lww.com/10.1097/CCE.0000000000000877 |
| spellingShingle | Andrew J. Goodwin, MD, MSCR Daniel L. Brinton, PhD Charles Terry, MD, MSCR George Carter, MD D. Clark Files, MD Katie Kirchoff, MS Dee W. Ford, MD, MSCR Annie N. Simpson, PhD Driving Pressure, Elastance, and Outcomes in a Real-World Setting: A Bi-Center Analysis of Electronic Health Record Data Critical Care Explorations |
| title | Driving Pressure, Elastance, and Outcomes in a Real-World Setting: A Bi-Center Analysis of Electronic Health Record Data |
| title_full | Driving Pressure, Elastance, and Outcomes in a Real-World Setting: A Bi-Center Analysis of Electronic Health Record Data |
| title_fullStr | Driving Pressure, Elastance, and Outcomes in a Real-World Setting: A Bi-Center Analysis of Electronic Health Record Data |
| title_full_unstemmed | Driving Pressure, Elastance, and Outcomes in a Real-World Setting: A Bi-Center Analysis of Electronic Health Record Data |
| title_short | Driving Pressure, Elastance, and Outcomes in a Real-World Setting: A Bi-Center Analysis of Electronic Health Record Data |
| title_sort | driving pressure elastance and outcomes in a real world setting a bi center analysis of electronic health record data |
| url | http://journals.lww.com/10.1097/CCE.0000000000000877 |
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