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RESEARCH PRODUCT
Do ventilatory parameters influence outcome in patients with severe acute respiratory infection? Secondary analysis of an international, multicentre14-day inception cohort study
Yasser SakrThais MidegaJulia AntoniazziJordi Solé-violánPhilippe R BauerMarlies OstermannTommaso PellisTamas SzakmanyKai ZacharowskiSilvio A ÑAmendys-silvaTài PhamRicard Ferrer RocaFabio S TacconeFrank Van HarenLaurent BrochardIc Glossary Investigators IncludingSanti Maurizio RaineriAndrea Cortegianisubject
ARDSSoins intensifs réanimationmedicine.medical_treatmentAirway pressuresPEEP positive end-expiratory pressureCritical Care and Intensive Care Medicinelaw.inventionHypoxemiaCohort StudiesPositive-Pressure RespirationMechanical ventilationSARI severe acute respiratory infectionlawHospital MortalityProspective StudiesIQR interquartile rangesProspective cohort studyRCT randomized controlled trialTidal volumeSOFA Sequential Organ Failure AssessmentSAPS Simplified Acute Physiology ScoreIntensive care unitVCV volume-controlled ventilationHIV human immunodeficiency virusIntensive Care UnitsIC GLOSSARI Intensive Care Global Study on Severe Acute Respiratory Infectionmedicine.symptomCohort studyLOS length of staymedicine.medical_specialtyVt tidal volumeCOPD Chronic obstructive pulmonary diseaseNYHA New York Heart Association.PCV pressure-controlled ventilationArticleInternal medicineICU Intensive Care UnitSIMV Synchronized intermittent mandatory ventilationmedicineTidal VolumeHumansDP driving pressurePEEPARDS acute respiratory distress syndromeMechanical ventilationbusiness.industryOdds ratioPneumoniaPlateau pressuremedicine.diseaseRespiration ArtificialVILI ventilator induced lung injuryCI confidence intervalOR odds ratioIMV invasive mechanical ventilationCPAP continuous positive airway pressureARDSbusinessSD standard deviationECMO extracorporeal membrane oxygenationPBW predicted body weightPplat plateau pressuredescription
Purpose: To investigate the possible association between ventilatory settings on the first day of invasive mechanical ventilation (IMV) and mortality in patients admitted to the intensive care unit (ICU) with severe acute respiratory infection (SARI). Materials and methods: In this pre-planned sub-study of a prospective, multicentre observational study, 441 patients with SARI who received controlled IMV during the ICU stay were included in the analysis. Results: ICU and hospital mortality rates were 23.1 and 28.1%, respectively. In multivariable analysis, tidal volume and respiratory rate on the first day of IMV were not associated with an increased risk of death; however, higher driving pressure (DP: odds ratio (OR) 1.05; 95% confidence interval (CI): 1.01–1.1, p = 0.011), plateau pressure (Pplat) (OR 1.08; 95% CI: 1.04–1.13, p < 0.001) and positive end-expiratory pressure (PEEP) (OR 1.13; 95% CI: 1.03–1.24, p = 0.006) were independently associated with in-hospital mortality. In subgroup analysis, in hypoxemic patients and in patients with acute respiratory distress syndrome (ARDS), higher DP, Pplat, and PEEP were associated with increased risk of in-hospital death. Conclusions: In patients with SARI receiving IMV, higher DP, Pplat and PEEP, and not tidal volume, were associated with a higher risk of in-hospital death, especially in those with hypoxemia or ARDS.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2021-12-01 |