Potentially modifiable respiratory variables contributing to outcome in ICU patients without ARDS: a secondary analysis of PRoVENT

Abstract

BackgroundThe majority of critically ill patients do not suffer from acute respiratory distress syndrome (ARDS). To improve the treatment of these patients, we aimed to identify potentially modifiable factors associated with outcome of these patients. MethodsThe PRoVENT was an international, multicenter, prospective cohort study of consecutive patients under invasive mechanical ventilatory support. A predefined secondary analysis was to examine factors associated with mortality. The primary endpoint was all-cause in-hospital mortality. Results935 Patients were included. In-hospital mortality was 21%. Compared to patients who died, patients who survived had a lower risk of ARDS according to the ‘Lung Injury Prediction Score’ and received lower maximum airway pressure (Pmax), driving pressure (ΔP), positive end-expiratory pressure, and FiO2 levels. Tidal volume size was similar between the groups. Higher Pmax was a potentially modifiable ventilatory variable associated with in-hospital mortality in multivariable analyses. ΔP was not independently associated with in-hospital mortality, but reliable values for ΔP were available for 343 patients only. Non-modifiable factors associated with in-hospital mortality were older age, presence of immunosuppression, higher non-pulmonary sequential organ failure assessment scores, lower pulse oximetry readings, higher heart rates, and functional dependence.ConclusionsHigher Pmax was independently associated with higher in-hospital mortality in mechanically ventilated critically ill patients under mechanical ventilatory support for reasons other than ARDS.Trial Registration ClinicalTrials.gov (NCT01868321).Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0385-7) contains supplementary material, which is available to authorized users.

Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome

“…We used the peak inspiratory pressure as a surrogate of airway pressures, because this is a measurement available in all modes of mechanical ventilation, and its association with mortality was shown in a recent cohort of ventilated patients. 41 Peak inspiratory pressure increased sequentially with severity of evolution categories, and in multivariable analysis, higher peak inspiratory pressure was associated with an increased risk of being in the group with worsening evolution.…”

Prediction of outcome in patients with ARDS: A prospective cohort study comparing ARDS-definitions and other ARDS-associated parameters, ratios and scores at intubation and over time

“…In a recent trial, all these factors were independently associated with higher probability of non-recognition of ARDS [1]. However, early recognition and grading of ARDS is crucial, since the effectiveness of several therapeutic measures depends on their early initiation [2,4,6,10,36]. This also applies to ECMO [28,37].…”

ERS International Congress, Madrid, 2019: highlights from the Respiratory Intensive Care Assembly

“…Approximately half of patients with ARDS in LUNG SAFE [22] and patients without ARDS in PRoVENT [23] received lung protective ventilation with a low V T and PEEP. While awaiting a detailed report on PRoVENT-iMiC [14], it can already be concluded that lung protective ventilation is also used in ICUs where resources are low.…”

“…There is increasing interest in driving pressure, the difference between the end-inspiratory plateau pressure and PEEP, as this parameter has a strong association with mortality and morbidity in patients with [22,24], as well as in patients without, ARDS [23].…”