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Multicenter Study
. 2022 Jul;48(7):888-898.
doi: 10.1007/s00134-022-06724-y. Epub 2022 Jun 7.

Partition of respiratory mechanics in patients with acute respiratory distress syndrome and association with outcome: a multicentre clinical study

Lu Chen  1   2 , Domenico L Grieco  3   4 , François Beloncle  5 , Guang-Qiang Chen  6 , Norberto Tiribelli  7 , Fabiana Madotto  8 , Sebastian Fredes  7   9 , Cong Lu  1   2 , Massimo Antonelli  3   4 , Alain Mercat  5 , Arthur S Slutsky  1   2 , Jian-Xin Zhou  6 , Laurent Brochard  10   11
Affiliations
Multicenter Study

Partition of respiratory mechanics in patients with acute respiratory distress syndrome and association with outcome: a multicentre clinical study

Lu Chen et al. Intensive Care Med. 2022 Jul.

Erratum in

Abstract

Purpose: In acute respiratory distress syndrome (ARDS), physiological parameters associated with outcome may help defining targets for mechanical ventilation. This study aimed to address whether transpulmonary pressures (PL), including transpulmonary driving pressure (DPL), elastance-derived plateau PL, and directly-measured end-expiratory PL, are better associated with 60-day outcome than airway driving pressure (DPaw). We also tested the combination of oxygenation and stretch index [PaO2/(FiO2*DPaw)].

Methods: Prospective, observational, multicentre registry of ARDS patients. Respiratory mechanics were measured early after intubation at 6 kg/ml tidal volume. We compared the predictive power of the parameters for mortality at day-60 through receiver operating characteristic (ROC) and assessed their association with 60-day mortality through unadjusted and adjusted Cox regressions. Finally, each parameter was dichotomized, and Kaplan-Meier survival curves were compared.

Results: 385 patients were enrolled 2 [1-4] days from intubation (esophageal pressure and arterial blood gases in 302 and 318 patients). As continuous variables, DPaw, DPL, and oxygenation stretch index were associated with 60-day mortality after adjustment for age and Sequential Organ Failure Assessment, whereas elastance-derived plateau PL was not. DPaw and DPL performed equally in ROC analysis (P = 0.0835). DPaw had the best-fit Cox regression model. When dichotomizing the variables, DPaw ≥ 15, DPL ≥ 12, plateau PL ≥ 24, and oxygenation stretch index < 10 exhibited lower 60-day survival probability. Directly measured end-expiratory PL ≥ 0 was associated with better outcome in obese patients.

Conclusion: DPL was equivalent predictor of outcome than DPaw. Our study supports the soundness of limiting lung and airway driving pressure and maintaining positive end-expiratory PL in obese patients.

Keywords: Acute respiratory distress syndrome; Artificial respiration; Mechanical ventilation; Positive-pressure respiration; Respiratory mechanics.

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Conflict of interest statement

All authors declared having no conflict of interest related to this work. Unrelated potential conflict are as follows: FB received research support from GE Healthcare, Medtronic and Getinge Group, consulting fees from Löwenstein Medical and travel fees from Air Liquide Medical System, which are not related to the present study. LB’s laboratory received research grants from Medtronic and Draeger, equipment from Sentec, Fisher Paykel, Philips and Air Liquide, and lecture fees from Fisher Paykel.

Figures

Fig. 1
Fig. 1
Flowchart of the study
Fig. 2
Fig. 2
Kaplan–Meier plots for patients who were measured esophageal pressure (n = 302). Patients were grouped by the dichotomized airway driving pressure (DPaw), transpulmonary driving pressure (DPL), elastance-derived plateau PL, and directly-measured end-expiratory PL, respectively
Fig. 3
Fig. 3
Kaplan–Meier plot for obese patients who were measured esophageal pressure (n = 123). Obesity was defined by body mass index ≥ 30 kg/m2, as per World Health Organization classification. Patients were grouped by the dichotomized end-expiratory PL. Notice that this is a post-hoc analysis
Fig. 4
Fig. 4
Kaplan–Meier plot for patients with arterial blood gas measurement (n = 318), who were grouped by the dichotomized oxygenation stretch index
See this image and copyright information in PMC

Comment in

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