Driving pressure is not associated with mortality in mechanically ventilated patients without ARDS
Driving pressure is not associated with mortality in mechanically ventilated patients without ARDS
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DOI：
10.1186/s13054-019-2698-9
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发表时间：
2019-12-27
期刊：
影响因子：
15.1
通讯作者：
Grissom, Colin K.
中科院分区：
文献类型：
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作者：
Lanspa, Michael J.;Peltan, Ithan D.;Grissom, Colin K.
在急性呼吸窘迫综合征（ARDS）患者中，低潮气量通气与降低死亡率相关。驱动压力（潮气量标准化呼吸系统顺应性）可能是一个更强的预测ARDS生存比潮气量。我们试图研究这些相关性是否适用于无ARDS的急性呼吸衰竭患者。方法对12家医院ICU收治的2年以上机械通气成人患者进行回顾性队列分析。我们使用自然语言处理胸片报告和电子病历数据来识别患有ARDS的患者。我们使用多变量logistic回归和广义线性模型，以急性生理学评分（APS）、Charlson合并症指数（CCI）、年龄和PaO 2/FiO（2）比值为协变量，估计潮气量、驱动压和呼吸系统顺应性与校正后30天死亡率之间的相关性。结果我们研究了2641例患者; 48%患有ARDS（n = 1273）。ARDS患者的平均APS评分较高（25 vs. 23，p <0.001），但CCI评分相似（4 vs. 3，p = 0.6）。对于非ARDS患者，潮气量与校正死亡率增加相关（潮气量每增加1 mL/kg PBW，OR 1.18，CI 1.04 - 1.35，p = 0.010）。我们没有观察到驱动压或呼吸顺应性与无ARDS患者的死亡率之间的相关性。在ARDS患者中，Delta P（OR 1.1，CI 1.06-1.14，p < 0.001）和潮气量（OR 1.17，CI 1.04-1.31，p = 0.007）与死亡率相关。结论：在一项对接受机械通气的非ARDS危重患者的大型回顾性分析中，我们发现潮气量与30天死亡率相关，而驱动压与30天死亡率无关。
Background In patients with acute respiratory distress syndrome (ARDS), low tidal volume ventilation has been associated with reduced mortality. Driving pressure (tidal volume normalized to respiratory system compliance) may be an even stronger predictor of ARDS survival than tidal volume. We sought to study whether these associations hold true in acute respiratory failure patients without ARDS. Methods This is a retrospectively cohort analysis of mechanically ventilated adult patients admitted to ICUs from 12 hospitals over 2 years. We used natural language processing of chest radiograph reports and data from the electronic medical record to identify patients who had ARDS. We used multivariable logistic regression and generalized linear models to estimate associations between tidal volume, driving pressure, and respiratory system compliance with adjusted 30-day mortality using covariates of Acute Physiology Score (APS), Charlson Comorbidity Index (CCI), age, and PaO2/FiO(2) ratio. Results We studied 2641 patients; 48% had ARDS (n = 1273). Patients with ARDS had higher mean APS (25 vs. 23, p < .001) but similar CCI (4 vs. 3, p = 0.6) scores. For non-ARDS patients, tidal volume was associated with increased adjusted mortality (OR 1.18 per 1 mL/kg PBW increase in tidal volume, CI 1.04 to 1.35, p = 0.010). We observed no association between driving pressure or respiratory compliance and mortality in patients without ARDS. In ARDS patients, both Delta P (OR1.1, CI 1.06-1.14, p < 0.001) and tidal volume (OR 1.17, CI 1.04-1.31, p = 0.007) were associated with mortality. Conclusions In a large retrospective analysis of critically ill non-ARDS patients receiving mechanical ventilation, we found that tidal volume was associated with 30-day mortality, while driving pressure was not.