Potentially modifiable respiratory variables contributing to outcome in ICU patients without ARDS: a secondary analysis of PRoVENT

Annals of Intensive Care - Tập 8 - Trang 1-12 - 2018
Fabienne D. Simonis1, Carmen S. V. Barbas2,3, Antonio Artigas-Raventós4, Jaume Canet5, Rogier M. Determann6, James Anstey7, Goran Hedenstierna8, Sabrine N. T. Hemmes9, Greet Hermans10,11, Michael Hiesmayr12, Markus W. Hollmann9, Samir Jaber13, Ignacio Martin-Loeches14,15, Gary H. Mills16, Rupert M. Pearse17, Christian Putensen18, Werner Schmid12, Paolo Severgnini19, Roger Smith7, Tanja A. Treschan20, Edda M. Tschernko12, Marcos F. Vidal Melo21, Hermann Wrigge22, Marcelo Gama de Abreu23,24, Paolo Pelosi25, Marcus J. Schultz1,26, Ary Serpa Neto1,2
1Department of Intensive Care and Lab. of Experimental Intensive Care and Anesthesiology (L E I C A), Academic Medical Center, Amsterdam, The Netherlands
2Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
3Department of Pulmonology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
4Department of Intensive Care Medicine and CIBER de Enfermedades Respiratorias, Hospital de Sabadell, Corporació Sanitaria I Universitària Parc Taulí, Sabadell, Spain
5Department of Anesthesiology, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain
6Department of Critical Care, Westfriesgasthuis, Hoorn, The Netherlands
7Department of Intensive Care, St. Vincent’s Hospital, Melbourne, Australia
8Department of Medical Sciences, Uppsala University, Uppsala, Sweden
9Department of Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands
10Medical Intensive Care Unit, Division of General Internal Medicine, University Hospital Leuven, Louvain, Belgium
11Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Louvain, Belgium
12Division of Cardiac, Thoracic, and Vascular Anesthesia and Intensive Care, Medical University Vienna, Vienna, Austria
13Department of Critical Care Medicine and Anesthesiology (SAR B), Saint Eloi University Hospital, Montpellier, France
14Department of Clinical Medicine, Trinity Centre for Health Sciences, Multidisciplinary Intensive Care Research Organization (MICRO), Welcome Trust, HRB Clinical Research, St James’s University Hospital Dublin, Dublin, Ireland
15Irish Centre for Vascular Biology, Irish Centre for Vascular Biology (ICVB), Dublin, Ireland
16Department of Anaesthesia and Critical Care Medicine, Sheffield Teaching Hospital, Sheffield, UK
17Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
18Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
19Department of Biotechnologies and Sciences of Life, Insubria University, Varese, Italy
20Department of Anaesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany
21Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
22Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany
23Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
24Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, Technische Universität Dresden, Dresden, Germany
25Department of Surgical Sciences and Integrated Diagnostics, Ospedale Policlinico per la Oncologia, IRCCS per l’Oncologia, University of Genoa, Genoa, Italy
26Mahidol Oxford Research Unit (MORU), Mahidol University, Bangkok, Thailand

Tóm tắt

The majority of critically ill patients do not suffer from acute respiratory distress syndrome (ARDS). To improve the treatment of these patients, we aimed to identify potentially modifiable factors associated with outcome of these patients. The PRoVENT was an international, multicenter, prospective cohort study of consecutive patients under invasive mechanical ventilatory support. A predefined secondary analysis was to examine factors associated with mortality. The primary endpoint was all-cause in-hospital mortality. 935 Patients were included. In-hospital mortality was 21%. Compared to patients who died, patients who survived had a lower risk of ARDS according to the ‘Lung Injury Prediction Score’ and received lower maximum airway pressure (Pmax), driving pressure (ΔP), positive end-expiratory pressure, and FiO2 levels. Tidal volume size was similar between the groups. Higher Pmax was a potentially modifiable ventilatory variable associated with in-hospital mortality in multivariable analyses. ΔP was not independently associated with in-hospital mortality, but reliable values for ΔP were available for 343 patients only. Non-modifiable factors associated with in-hospital mortality were older age, presence of immunosuppression, higher non-pulmonary sequential organ failure assessment scores, lower pulse oximetry readings, higher heart rates, and functional dependence. Higher Pmax was independently associated with higher in-hospital mortality in mechanically ventilated critically ill patients under mechanical ventilatory support for reasons other than ARDS. Trial Registration ClinicalTrials.gov (NCT01868321).

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Annals of Intensive Care

Tập 8

1-12

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