Partition of respiratory mechanics in patients with acute respiratory distress syndrome and association with outcome: a multicentre clinical study

Purpose In acute respiratory distress syndrome (ARDS), physiological parameters associated with outcome may help defining targets for mechanical ventilation. This study aimed to address whether transpulmonary pressures ( P L ), including transpulmonary driving pressure (DP L ), elastance-derived pla...

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Bibliographic Details
Published in:Intensive care medicine 2022-07, Vol.48 (7), p.888-898
Main Authors: Chen, Lu, Grieco, Domenico L., Beloncle, François, Chen, Guang-Qiang, Tiribelli, Norberto, Madotto, Fabiana, Fredes, Sebastian, Lu, Cong, Antonelli, Massimo, Mercat, Alain, Slutsky, Arthur S., Zhou, Jian-Xin, Brochard, Laurent
Format: Article
Language:English
Subjects:
Acute respiratory distress syndrome
Anesthesiology
Blood pressure
Canada
Care and treatment
Chen Lu
Clinical trials
Comparative analysis
Continuity (mathematics)
Critical Care Medicine
Emergency Medicine
Humans
Intensive
Intensive care
Intubation
Mechanical ventilation
Mechanics (physics)
Medicine
Medicine & Public Health
Mortality
Obesity
Original
Oxygenation
Pain Medicine
Parameters
Patient outcomes
Patients
Pediatrics
Physiological aspects
Pneumology/Respiratory System
Positive-Pressure Respiration
Prospective Studies
Regression models
Respiration, Artificial
Respiratory distress syndrome
Respiratory Distress Syndrome - therapy
Respiratory Mechanics - physiology
Respiratory tract
Statistical analysis
Survival
Taiwan
Tidal Volume
United Kingdom
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Summary:Purpose In acute respiratory distress syndrome (ARDS), physiological parameters associated with outcome may help defining targets for mechanical ventilation. This study aimed to address whether transpulmonary pressures ( P L ), including transpulmonary driving pressure (DP L ), elastance-derived plateau P L , and directly-measured end-expiratory P L , are better associated with 60-day outcome than airway driving pressure (DP aw ). We also tested the combination of oxygenation and stretch index [PaO 2 /(FiO 2 *DP aw )]. Methods Prospective, observational, multicentre registry of ARDS patients. Respiratory mechanics were measured early after intubation at 6 kg/ml tidal volume. We compared the predictive power of the parameters for mortality at day-60 through receiver operating characteristic (ROC) and assessed their association with 60-day mortality through unadjusted and adjusted Cox regressions. Finally, each parameter was dichotomized, and Kaplan–Meier survival curves were compared. Results 385 patients were enrolled 2 [1–4] days from intubation (esophageal pressure and arterial blood gases in 302 and 318 patients). As continuous variables, DP aw , DP L , and oxygenation stretch index were associated with 60-day mortality after adjustment for age and Sequential Organ Failure Assessment, whereas elastance-derived plateau P L was not. DP aw and DP L performed equally in ROC analysis ( P  = 0.0835). DP aw had the best-fit Cox regression model. When dichotomizing the variables, DP aw  ≥ 15, DP L  ≥ 12, plateau P L  ≥ 24, and oxygenation stretch index 
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-022-06724-y