Association between hospital mortality and inspiratory airway pressures in mechanically ventilated patients without acute respiratory distress syndrome: a prospective cohort study

• Type of Material: Article
• Authors: Sarina K. Sahetya, Johns Hopkins University; Christopher Mallow, Johns Hopkins University; Jonathan Sevransky, Emory University; Greg Martin, Emory University; Timothy D. Girard, University of Pittsburgh; Roy G. Brower, Johns Hopkins University; William Checkley, Johns Hopkins University
• Language: English
• Date: 2019-11-21
• Publisher: BMC (part of Springer Nature)
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s). 2019
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s13054-019-2635-y
• Title of Journal or Parent Work: Critical Care
• ISSN: 1364-8535
• Volume: 23
• Issue: 1
• Start Page: 367
• End Page: 367
• Grant/Funding Information: The research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number T32HL007534 (SS and CM) and the Pearl M. Stetler Research Fellowship (SS).; Dr. Martin (GM) was supported in part by the NIH under award UL1 TR-000454 (NCATS).
• Keywords: ARDS; Acute respiratory failure; Mechanical ventilation; Driving pressure
• Research Categories: Health Sciences, Medicine and Surgery

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.