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Do ventilatory parameters influence outcome in patients with severe acute respiratory infection? Secondary analysis of an international, multicentre14-day inception cohort study

Sakr, Yasser, Midega, Thais, Antoniazzi, Julia, Solé-Violán, Jordi, Bauer, Philippe R., Ostermann, Marlies, Pellis, Tommaso, Szakmany, Tamas, Zacharowski, Kai, Ñamendys-Silva, Silvio A., Pham, Tài, Ferrer, Ricard, Taccone, Fabio S., van Haren, Frank and Brochard, Laurent 2021. Do ventilatory parameters influence outcome in patients with severe acute respiratory infection? Secondary analysis of an international, multicentre14-day inception cohort study. Journal of Critical Care 66 , pp. 78-85. 10.1016/j.jcrc.2021.08.008

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Abstract

Purpose To investigate the possible association between ventilatory settings on the first day of invasive mechanical ventilation (IMV) and mortality in patients admitted to the intensive care unit (ICU) with severe acute respiratory infection (SARI). Materials and methods In this pre-planned sub-study of a prospective, multicentre observational study, 441 patients with SARI who received controlled IMV during the ICU stay were included in the analysis. Results ICU and hospital mortality rates were 23.1 and 28.1%, respectively. In multivariable analysis, tidal volume and respiratory rate on the first day of IMV were not associated with an increased risk of death; however, higher driving pressure (DP: odds ratio (OR) 1.05; 95% confidence interval (CI): 1.01–1.1, p = 0.011), plateau pressure (Pplat) (OR 1.08; 95% CI: 1.04–1.13, p < 0.001) and positive end-expiratory pressure (PEEP) (OR 1.13; 95% CI: 1.03–1.24, p = 0.006) were independently associated with in-hospital mortality. In subgroup analysis, in hypoxemic patients and in patients with acute respiratory distress syndrome (ARDS), higher DP, Pplat, and PEEP were associated with increased risk of in-hospital death. Conclusions In patients with SARI receiving IMV, higher DP, Pplat and PEEP, and not tidal volume, were associated with a higher risk of in-hospital death, especially in those with hypoxemia or ARDS.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Elsevier
ISSN: 0883-9441
Date of First Compliant Deposit: 15 September 2021
Date of Acceptance: 22 July 2021
Last Modified: 21 Sep 2021 12:45
URI: http://orca.cardiff.ac.uk/id/eprint/144141

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