The impact of respiratory variables  on mortality in non-ARDS and ARDS patients requiring mechanical ventilation

Luhr, O.; Karlsson, Magnus K.; Thorsteinsson, Adalbjörn; Rylander, Christian; Frostell, Claes

doi:10.1007/s001340051197

Cited by 75 publications

(60 citation statements)

References 19 publications

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“…The value of pH in our study was higher than that reported in the studies by Brun-Buisson and Villar (7.35 vs. 7.30), and the difference may due to the inconsistence in patients selection (42,43). Controversies lies in the association between PaO 2 /FiO 2 at the onset of ARDS and the adverse outcomes in ARDS (42)(43)(44)(45), but our study revealed that initial PaO 2 /FiO 2 is not an independent predictor of mortality, which we suspected was attributed to the insignificant difference in PEEP because PaO 2 /FiO 2 has been reported to vary depending on ventilator strategy and is sensitive to ventilator settings (46), and early change of PaO 2 /FiO 2 being too likely to be associated with outcomes in ARDS (10,47).…”

Section: Discussionmentioning

confidence: 99%

Early identification of patients at risk for acute respiratory distress syndrome among severe pneumonia: a retrospective cohort study

Luo

et al. 2017

J. Thorac. Dis.

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Background: Severe pneumonia is the predominant cause for acute respiratory distress syndrome (ARDS).Identification of ARDS from patients with severe pneumonia remains a significant clinical problem due to the overlap of clinical presentations and symptoms. Early recognition of risks for ARDS from severe pneumonia is of great clinical value.Methods: From April 2014 to December 2015, patients with severe pneumonia at admission were retrieved from the hospital database, of which ARDS developed within 7 days were further identified. We compared the demographic and clinical characteristics at admission between severe pneumonia patients with and without ARDS development, followed by analysis of potential predictors for ARDS development and mortality. Multivariate logistic regression and receiver operating characteristic (ROC) curves were performed to screen independent risk factors and identify their sensitivity in predicting ARDS development and prognosis.Results: Compared with severe pneumonia without ARDS development, patients with ARDS development had shorter disease duration before admission, higher lung injury score (LIS), serum fibrinogen (FiB), and positive end-expiratory pressure (PEEP), lower Marshall score, sequential organ failure assessment score and proportion of cardiovascular and gastrointestinal diseases, but similar mortality. Serum FiB >5.15 g/L [adjusted odds ratio (OR) 1.893, 95% confidence interval (CI): 1.141-3.142, P=0.014] and PEEP >6.5 cmH 2 O (adjusted OR 1.651, 95% CI: 1.218-2.237, P=0.001) were independent predictors for ARDS development with a sensitivity of 58.3% and 87.5%, respectively, and pH <7.35 (adjusted OR 0.832, 95% CI: 0.702-0.985, P=0.033) was an independent risk factor for ARDS mortality with a sensitivity of 95.2%.Conclusions: ARDS development risk could be early recognized by PEEP >6.5 cmH 2 O and serum FiB >5.15 g/L in severe pneumonia patients, and pH <7.35 is a reliable prognostic factor in predicting ARDS mortality risk.

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Section: Discussionmentioning

confidence: 99%

Early identification of patients at risk for acute respiratory distress syndrome among severe pneumonia: a retrospective cohort study

Luo

et al. 2017

J. Thorac. Dis.

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“…In patients with adult respiratory distress syndrome older age is clearly associated with higher mortality rates. 87,88 Similar data specific to mechanical ventilation made necessary by postoperative pulmonary complications are not available. Ely et al 89 prospectively studied whether age represents an independent effect on the outcomes of patients requiring mechanical ventilation after admission to an intensive care unit.…”

Section: Non-invasive Ventilationmentioning

confidence: 99%

Review article: Age related alterations in respiratory function — anesthetic considerations

Šprung

Gajic

Warner

2006

Can J Anesth/J Can Anesth

143

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Purpose: This review examines the effect of aging on pulmonary reserve. Special emphasis is placed on how anesthetic and surgical factors may impose substantial stresses on the respiratory system of elderly patients, leading to increased risk for postoperative pulmonary complications including respiratory failure.Source: A MEDLINE-based English-language literature search was undertaken for the period 1966-2006, and an EMBASE search covered the overlapping period 1988-2006. Selected articles were limited to those applying to elderly subjects/patients. Principal findings:Age-related loss of the lung static recoil forces, stiffening of the chest wall and diminished alveolar surface area lead to a decrease in vital capacity, an increase in residual volume, decrease in expiratory flows and increased ventilation-perfusion heterogeneity. Respiratory muscle strength consistently declines with age further increasing the work of breathing. While gas exchange may be well preserved at rest and during exertion, pulmonary reserve is diminished, and under conditions of positive fluid balance, positioning for surgery, and increased metabolic demand, postoperative respiratory failure can occur. Increased sensitivity to respiratory depressants and muscle weakness pose additional risks for the development of postoperative respiratory complications in elderly patients. Regional anesthetic techniques provide for superior postoperative analgesia, without necessarily altering the frequency of postoperative pulmonary complications in the older surgical population. Conclusion:Alterations in respiratory physiology associated with aging must be appreciated to anticipate and minimize potential complications associated with surgery and anesthesia in the elderly. Individualized care to optimize preoperative cardiorespiratory function, minimize intraoperative respiratory pertubations, and to gently restore postoperative pulmonary function are essential anesthetic goals for elderly patients who require surgery. Objectif

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“…It is therefore important to improve respiratory care of these patients [11,25,95,96]. Animal studies play an important part in expanding our knowledge in this research area, leading to better clinical routines to minimize the risks associated with mechanical ventilation.…”

Section: Ethical Issuesmentioning

confidence: 99%

Regional lung derecruitment after endotracheal suction during volume- or pressure-controlled ventilation: a study using electric impedance tomography

et al. 2006

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The impact of respiratory variables on mortality in non-ARDS and ARDS patients requiring mechanical ventilation

Cited by 75 publications

References 19 publications

Early identification of patients at risk for acute respiratory distress syndrome among severe pneumonia: a retrospective cohort study

Early identification of patients at risk for acute respiratory distress syndrome among severe pneumonia: a retrospective cohort study

Review article: Age related alterations in respiratory function — anesthetic considerations

Regional lung derecruitment after endotracheal suction during volume- or pressure-controlled ventilation: a study using electric impedance tomography

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