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. 2018 Mar 21;8(1):39.
doi: 10.1186/s13613-018-0385-7.

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

Fabienne D Simonis  1 , Carmen S V Barbas  2   3 , Antonio Artigas-Raventós  4 , Jaume Canet  5 , Rogier M Determann  6 , James Anstey  7 , Goran Hedenstierna  8 , Sabrine N T Hemmes  9 , Greet Hermans  10   11 , Michael Hiesmayr  12 , Markus W Hollmann  9 , Samir Jaber  13 , Ignacio Martin-Loeches  14   15 , Gary H Mills  16 , Rupert M Pearse  17 , Christian Putensen  18 , Werner Schmid  12 , Paolo Severgnini  19 , Roger Smith  7 , Tanja A Treschan  20 , Edda M Tschernko  12 , Marcos F Vidal Melo  21 , Hermann Wrigge  22 , Marcelo Gama de Abreu  23   24 , Paolo Pelosi  25 , Marcus J Schultz  26   27 , Ary Serpa Neto  26   2 ; PRoVENT investigators; PROVE Network investigators
Collaborators, Affiliations

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

Fabienne D Simonis et al. Ann Intensive Care. .

Abstract

Background: The 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.

Methods: The 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.

Results: 935 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.

Conclusions: Higher 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).

Keywords: Mechanical ventilation; Mortality; Outcome; Ventilator settings.

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Figures

Fig. 1
Fig. 1
Flowchart of inclusion
Fig. 2
Fig. 2
Unadjusted relative risks of hospital mortality in the overall cohort and in patients at risk and not at risk of ARDS and according to the median of the: a Pmax; b PEEP; c ∆P; and d tidal volume. Abbreviations: Pmax: maximum airway pressure; PEEP: positive end-expiratory pressure; VT: tidal volume; ∆P: driving pressure; RR: relative risk; CI: confidence interval
Fig. 3
Fig. 3
Odds ratio of hospital mortality according to increases in one standard deviation of Pmax and in the patients at risk and not at risk of ARDS. All curves are adjusted by the same set of variables described in Table 3
See this image and copyright information in PMC

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