The relationship of tidal volume and driving pressure with mortality in hypoxic patients receiving mechanical ventilation.
<h4>Purpose</h4>To determine whether tidal volume/predicted body weight (TV/PBW) or driving pressure (DP) are associated with mortality in a heterogeneous population of hypoxic mechanically ventilated patients.<h4>Methods</h4>A retrospective cohort study involving 18 intensiv...
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2021
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oai:doaj.org-article:4966a9690844426283552c353307d5972021-12-02T20:18:30ZThe relationship of tidal volume and driving pressure with mortality in hypoxic patients receiving mechanical ventilation.1932-620310.1371/journal.pone.0255812https://doaj.org/article/4966a9690844426283552c353307d5972021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0255812https://doaj.org/toc/1932-6203<h4>Purpose</h4>To determine whether tidal volume/predicted body weight (TV/PBW) or driving pressure (DP) are associated with mortality in a heterogeneous population of hypoxic mechanically ventilated patients.<h4>Methods</h4>A retrospective cohort study involving 18 intensive care units included consecutive patients ≥18 years old, receiving mechanical ventilation for ≥3 days, with a PaO2/FiO2 ratio ≤300 mmHg, whether or not they met full criteria for ARDS. The main outcome was hospital mortality. Multiple logistic regression (MLR) incorporated TV/PBW, DP, and potential confounders including age, APACHE IVa® predicted hospital mortality, respiratory system compliance (CRS), and PaO2/FiO2. Predetermined strata of TV/PBW were compared using MLR.<h4>Results</h4>Our cohort comprised 5,167 patients with mean age 61.9 years, APACHE IVa® score 79.3, PaO2/FiO2 166 mmHg and CRS 40.5 ml/cm H2O. Regression analysis revealed that patients receiving DP one standard deviation above the mean or higher (≥19 cmH20) had an adjusted odds ratio for mortality (ORmort) = 1.10 (95% CI: 1.06-1.13, p = 0.009). Regression analysis showed a U-shaped relationship between strata of TV/PBW and adjusted mortality. Using TV/PBW 4-6 ml/kg as the referent group, patients receiving >10 ml/kg had similar adjusted ORmort, but those receiving 6-7, 7-8 and 8-10 ml/kg had lower adjusted ORmort (95%CI) of 0.81 (0.65-1.00), 0.78 (0.63-0.97) and 0.80 0.67-1.01) respectively. The adjusted ORmort in patients receiving 4-6 ml/kg was 1.26 (95%CI: 1.04-1.52) compared to patients receiving 6-10 ml/kg.<h4>Conclusions</h4>Driving pressures ≥19 cmH2O were associated with increased adjusted mortality. TV/PBW 4-6ml/kg were used in less than 15% of patients and associated with increased adjusted mortality compared to TV/PBW 6-10 ml/kg used in 82% of patients. Prospective clinical trials are needed to prove whether limiting DP or the use of TV/PBW 6-10 ml/kg versus 4-6 ml/kg benefits mortality.Robert A RaschkeBrenda StofferSeth AssarStephanie FountainKurt OlsenC William HeiseTyler GalloAngela Padilla-JonesRichard GerkinSairam ParthasarathySteven C CurryPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 8, p e0255812 (2021) |
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Medicine R Science Q Robert A Raschke Brenda Stoffer Seth Assar Stephanie Fountain Kurt Olsen C William Heise Tyler Gallo Angela Padilla-Jones Richard Gerkin Sairam Parthasarathy Steven C Curry The relationship of tidal volume and driving pressure with mortality in hypoxic patients receiving mechanical ventilation. |
| description |
<h4>Purpose</h4>To determine whether tidal volume/predicted body weight (TV/PBW) or driving pressure (DP) are associated with mortality in a heterogeneous population of hypoxic mechanically ventilated patients.<h4>Methods</h4>A retrospective cohort study involving 18 intensive care units included consecutive patients ≥18 years old, receiving mechanical ventilation for ≥3 days, with a PaO2/FiO2 ratio ≤300 mmHg, whether or not they met full criteria for ARDS. The main outcome was hospital mortality. Multiple logistic regression (MLR) incorporated TV/PBW, DP, and potential confounders including age, APACHE IVa® predicted hospital mortality, respiratory system compliance (CRS), and PaO2/FiO2. Predetermined strata of TV/PBW were compared using MLR.<h4>Results</h4>Our cohort comprised 5,167 patients with mean age 61.9 years, APACHE IVa® score 79.3, PaO2/FiO2 166 mmHg and CRS 40.5 ml/cm H2O. Regression analysis revealed that patients receiving DP one standard deviation above the mean or higher (≥19 cmH20) had an adjusted odds ratio for mortality (ORmort) = 1.10 (95% CI: 1.06-1.13, p = 0.009). Regression analysis showed a U-shaped relationship between strata of TV/PBW and adjusted mortality. Using TV/PBW 4-6 ml/kg as the referent group, patients receiving >10 ml/kg had similar adjusted ORmort, but those receiving 6-7, 7-8 and 8-10 ml/kg had lower adjusted ORmort (95%CI) of 0.81 (0.65-1.00), 0.78 (0.63-0.97) and 0.80 0.67-1.01) respectively. The adjusted ORmort in patients receiving 4-6 ml/kg was 1.26 (95%CI: 1.04-1.52) compared to patients receiving 6-10 ml/kg.<h4>Conclusions</h4>Driving pressures ≥19 cmH2O were associated with increased adjusted mortality. TV/PBW 4-6ml/kg were used in less than 15% of patients and associated with increased adjusted mortality compared to TV/PBW 6-10 ml/kg used in 82% of patients. Prospective clinical trials are needed to prove whether limiting DP or the use of TV/PBW 6-10 ml/kg versus 4-6 ml/kg benefits mortality. |
| format |
article |
| author |
Robert A Raschke Brenda Stoffer Seth Assar Stephanie Fountain Kurt Olsen C William Heise Tyler Gallo Angela Padilla-Jones Richard Gerkin Sairam Parthasarathy Steven C Curry |
| author_facet |
Robert A Raschke Brenda Stoffer Seth Assar Stephanie Fountain Kurt Olsen C William Heise Tyler Gallo Angela Padilla-Jones Richard Gerkin Sairam Parthasarathy Steven C Curry |
| author_sort |
Robert A Raschke |
| title |
The relationship of tidal volume and driving pressure with mortality in hypoxic patients receiving mechanical ventilation. |
| title_short |
The relationship of tidal volume and driving pressure with mortality in hypoxic patients receiving mechanical ventilation. |
| title_full |
The relationship of tidal volume and driving pressure with mortality in hypoxic patients receiving mechanical ventilation. |
| title_fullStr |
The relationship of tidal volume and driving pressure with mortality in hypoxic patients receiving mechanical ventilation. |
| title_full_unstemmed |
The relationship of tidal volume and driving pressure with mortality in hypoxic patients receiving mechanical ventilation. |
| title_sort |
relationship of tidal volume and driving pressure with mortality in hypoxic patients receiving mechanical ventilation. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2021 |
| url |
https://doaj.org/article/4966a9690844426283552c353307d597 |
| work_keys_str_mv |
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