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. 2019 Dec 27;23(1):424.
doi: 10.1186/s13054-019-2698-9.

Driving pressure is not associated with mortality in mechanically ventilated patients without ARDS

Michael J Lanspa  1   2 , Ithan D Peltan  3   4 , Jason R Jacobs  3 , Jeffrey S Sorensen  3 , Lori Carpenter  3 , Jeffrey P Ferraro  5   6 , Samuel M Brown  3   4 , Jay G Berry  7 , Raj Srivastava  8   9 , Colin K Grissom  3   4
Affiliations

Driving pressure is not associated with mortality in mechanically ventilated patients without ARDS

Michael J Lanspa et al. Crit Care. .

Abstract

Background: In patients with acute respiratory distress syndrome (ARDS), low tidal volume ventilation has been associated with reduced mortality. Driving pressure (tidal volume normalized to respiratory system compliance) may be an even stronger predictor of ARDS survival than tidal volume. We sought to study whether these associations hold true in acute respiratory failure patients without ARDS.

Methods: This is a retrospectively cohort analysis of mechanically ventilated adult patients admitted to ICUs from 12 hospitals over 2 years. We used natural language processing of chest radiograph reports and data from the electronic medical record to identify patients who had ARDS. We used multivariable logistic regression and generalized linear models to estimate associations between tidal volume, driving pressure, and respiratory system compliance with adjusted 30-day mortality using covariates of Acute Physiology Score (APS), Charlson Comorbidity Index (CCI), age, and PaO2/FiO2 ratio.

Results: We studied 2641 patients; 48% had ARDS (n = 1273). Patients with ARDS had higher mean APS (25 vs. 23, p < .001) but similar CCI (4 vs. 3, p = 0.6) scores. For non-ARDS patients, tidal volume was associated with increased adjusted mortality (OR 1.18 per 1 mL/kg PBW increase in tidal volume, CI 1.04 to 1.35, p = 0.010). We observed no association between driving pressure or respiratory compliance and mortality in patients without ARDS. In ARDS patients, both ΔP (OR1.1, CI 1.06-1.14, p < 0.001) and tidal volume (OR 1.17, CI 1.04-1.31, p = 0.007) were associated with mortality.

Conclusions: In a large retrospective analysis of critically ill non-ARDS patients receiving mechanical ventilation, we found that tidal volume was associated with 30-day mortality, while driving pressure was not.

Keywords: ARDS; Driving pressure; Low tidal volume ventilation; Lung protective ventilation; Respiratory compliance.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient inclusion diagram. VC: Volume-control ventilation. ARDS: acute respiratory distress syndrome. Extreme values are > 99th percentile of ΔP, tidal volume, or CRS, attributed to charting errors. Patients with missing values for ΔP, tidal volume, or CRS were excluded from primary analysis, but used for sensitivity analyses after imputing missing values
Fig. 2
Fig. 2
Estimated risk of 30-day mortality as a function of tidal volume, driving pressure, and respiratory system compliance among patients with and without ARDS, from generalized linear models. Hash marks indicated observed value for the exposures. Gray bands represent ± 2 standard errors
See this image and copyright information in PMC

Comment in

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