High Positive End-Expiratory Pressure Is Associated with Improved Survival in Obese Patients with Acute Respiratory Distress Syndrome - 18/04/17
, Mallorie Fiero, PhD c, Zhenqiang Lu, PhD b, d, Eyal Oren, PhD, MS c, Cristine E. Berry, MD, MHS a, b, Sairam Parthasarathy, MD a, b, Joe G.N. Garcia, MD a, bAbstract |
Background |
In acute respiratory distress syndrome, minimizing lung injury from repeated collapse and reopening of alveoli by applying a high positive end-expiratory pressure improves oxygenation without influencing mortality. Obesity causes alveolar atelectasis, thus suggesting that a higher positive end-expiratory pressure might be more protective among the obese. We hypothesized that the effect of applying a high positive end-expiratory pressure on mortality from acute respiratory distress syndrome would differ by obesity status.
Methods |
This was a retrospective analysis of 505 patients from the Assessment of Low tidal Volume and elevated End-expiratory volume to Obviate Lung Injury Trial, a multicenter randomized trial that compared a higher vs a lower positive end-expiratory pressure ventilatory strategy in acute respiratory distress syndrome. We examined the relationship between positive end-expiratory pressure strategy and 60-day mortality stratified by obesity status.
Results |
Among obese patients with acute respiratory distress syndrome, those assigned to a high positive end-expiratory pressure strategy experienced lower mortality compared with those assigned to a low strategy (18% vs 32%; P = .04). Among the nonobese, those assigned to high positive end-expiratory pressure strategy experienced similar mortality with those assigned to low strategy (34% vs 23%; P = .13). Multivariate analysis demonstrated an interaction between obesity status and the effect of positive end-expiratory pressure strategy on mortality (P <.01).
Conclusions |
Ventilation with higher levels of positive end-expiratory pressure was associated with improved survival among the subgroup of patients with acute respiratory distress syndrome who are obese.
Le texte complet de cet article est disponible en PDF.Keywords : Adult, ARDS, Mortality, Obesity, PEEP, Survival
Plan
| Funding: CB was supported for this work by the University of Arizona Health Sciences Center Career Development Grant. |
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| Conflict of Interest: All authors report no conflicts of interest. |
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| Authorship: All authors participated in making substantial contributions to the conception or design of the work, the acquisition of the data from home/, the analysis and interpretation of data for the work, the drafting and revision of the manuscript. |
Vol 130 - N° 2
P. 207-213 - février 2017 Retour au numéro
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