tetano
Editor, Senior Moderator
Crit Care Sci
. 2024 May 10:36:e20240208en.
doi: 10.62675/2965-2774.20240208-en. eCollection 2024. Driving pressure, as opposed to tidal volume based on predicted body weight, is associated with mortality: results from a prospective cohort of COVID-19 acute respiratory distress syndrome patients
[Article in English, Portuguese]
Erich Vidal Carvalho[SUP] 1 [/SUP], Maycon Moura Reboredo[SUP] 1 [/SUP], Edimar Pedrosa Gomes[SUP] 1 [/SUP], Pedro Nascimento Martins[SUP] 1 [/SUP], Gabriel Paz Souza Mota[SUP] 1 [/SUP], Giovani Bernardo Costa[SUP] 1 [/SUP], Fernando Antonio Basile Colugnati[SUP] 1 [/SUP], Bruno Valle Pinheiro[SUP] 1 [/SUP]
Affiliations
Objective: To evaluate the association between driving pressure and tidal volume based on predicted body weight and mortality in a cohort of patients with acute respiratory distress syndrome caused by COVID-19.
Methods: This was a prospective, observational study that included patients with acute respiratory distress syndrome due to COVID-19 admitted to two intensive care units. We performed multivariable analyses to determine whether driving pressure and tidal volume/kg predicted body weight on the first day of mechanical ventilation, as independent variables, are associated with hospital mortality.
Results: We included 231 patients. The mean age was 64 (53 - 74) years, and the mean Simplified Acute and Physiology Score 3 score was 45 (39 - 54). The hospital mortality rate was 51.9%. Driving pressure was independently associated with hospital mortality (odds ratio 1.21, 95%CI 1.04 - 1.41 for each cm H2O increase in driving pressure, p = 0.01). Based on a double stratification analysis, we found that for the same level of tidal volume/kg predicted body weight, the risk of hospital death increased with increasing driving pressure. However, changes in tidal volume/kg predicted body weight were not associated with mortality when they did not lead to an increase in driving pressure.
Conclusion: In patients with acute respiratory distress syndrome caused by COVID-19, exposure to higher driving pressure, as opposed to higher tidal volume/kg predicted body weight, is associated with greater mortality. These results suggest that driving pressure might be a primary target for lung-protective mechanical ventilation in these patients.
. 2024 May 10:36:e20240208en.
doi: 10.62675/2965-2774.20240208-en. eCollection 2024. Driving pressure, as opposed to tidal volume based on predicted body weight, is associated with mortality: results from a prospective cohort of COVID-19 acute respiratory distress syndrome patients
[Article in English, Portuguese]
Erich Vidal Carvalho[SUP] 1 [/SUP], Maycon Moura Reboredo[SUP] 1 [/SUP], Edimar Pedrosa Gomes[SUP] 1 [/SUP], Pedro Nascimento Martins[SUP] 1 [/SUP], Gabriel Paz Souza Mota[SUP] 1 [/SUP], Giovani Bernardo Costa[SUP] 1 [/SUP], Fernando Antonio Basile Colugnati[SUP] 1 [/SUP], Bruno Valle Pinheiro[SUP] 1 [/SUP]
Affiliations
- PMID: 38747818
- DOI: 10.62675/2965-2774.20240208-en
Objective: To evaluate the association between driving pressure and tidal volume based on predicted body weight and mortality in a cohort of patients with acute respiratory distress syndrome caused by COVID-19.
Methods: This was a prospective, observational study that included patients with acute respiratory distress syndrome due to COVID-19 admitted to two intensive care units. We performed multivariable analyses to determine whether driving pressure and tidal volume/kg predicted body weight on the first day of mechanical ventilation, as independent variables, are associated with hospital mortality.
Results: We included 231 patients. The mean age was 64 (53 - 74) years, and the mean Simplified Acute and Physiology Score 3 score was 45 (39 - 54). The hospital mortality rate was 51.9%. Driving pressure was independently associated with hospital mortality (odds ratio 1.21, 95%CI 1.04 - 1.41 for each cm H2O increase in driving pressure, p = 0.01). Based on a double stratification analysis, we found that for the same level of tidal volume/kg predicted body weight, the risk of hospital death increased with increasing driving pressure. However, changes in tidal volume/kg predicted body weight were not associated with mortality when they did not lead to an increase in driving pressure.
Conclusion: In patients with acute respiratory distress syndrome caused by COVID-19, exposure to higher driving pressure, as opposed to higher tidal volume/kg predicted body weight, is associated with greater mortality. These results suggest that driving pressure might be a primary target for lung-protective mechanical ventilation in these patients.