BACKGROUND: Ventilation with low tidal volume is recommended for patients with acute lung injury. Current guidelines suggest limiting plateau pressure (P plat ) to < 30 cm H 2 O for septic patients needing mechanical ventilation. The aim of this study was to determine whether P plat within the first 24 h of ICU admission is predictive of outcome and whether P plat < 30 cm H 2 O is associated with lower mortality rates. METHODS: This study was a retrospective analysis of prospectively acquired clinical data from an ICU of a tertiary referral hospital in central Taiwan. Subjects were included if they were admitted due to sepsis and respiratory failure requiring mechanical ventilation from April 2008 to November 2009. RESULTS: There were 220 subjects (188 males, 32 females) with a median age of 76 y and a mean Acute Physiology and Chronic Health Evaluation II score of 25.0 ؎ 6.5. Pneumonia was the major cause of sepsis (85.5%). The hospital mortality rate was 39.1%. P plat was higher throughout the first 24 h of ICU admission in nonsurvivors. Higher P plat was associated with higher mortality rates regardless of acute lung injury. In multivariate regression analysis, P plat > 25 cm H 2 O at 24 h after admission was an independent risk factor for mortality (adjusted odds ratio of 2.33, 95% CI 1.10 -4.91, P ؍ .03 for hospital mortality). CONCLUSIONS: P plat within the first 24 h of ICU admission is predictive of outcome, with lower P plat associated with lower mortality rates. There is no safety margin for P plat . Limiting P plat should be considered even at < 30 cm H 2 O in septic patients with acute respiratory failure.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.