Potentially modifiable respiratory variables contributing to outcome in ICU patients without ARDS: a secondary analysis of PRoVENT - 08/01/26

Doi : 10.1186/s13613-018-0385-7

Fabienne D. Simonis ¹ , Carmen S.V. Barbas ^2,³ , Antonio Artigas-Raventós ⁴ , Jaume Canet ⁵ , Rogier M. Determann ⁶ , James Anstey ⁷ , Goran Hedenstierna ⁸ , Sabrine N.T. Hemmes ⁹ , Greet Hermans ^10,¹¹ , Michael Hiesmayr ¹² , Markus W. Hollmann ⁹ , Samir Jaber ¹³ , Ignacio Martin-Loeches ^14,¹⁵ , Gary H. Mills ¹⁶ , Rupert M. Pearse ¹⁷ , Christian Putensen ¹⁸ , Werner Schmid ¹² , Paolo Severgnini ¹⁹ , Roger Smith ⁷ , Tanja A. Treschan ²⁰ , Edda M. Tschernko ¹² , Marcos F. Vidal Melo ²¹ , Hermann Wrigge ²² , Marcelo Gama de Abreu ^23,²⁴ , Paolo Pelosi ²⁵ , Marcus J. Schultz ^1,²⁶ , Ary Serpa Neto ^1,²
For the PRoVENT investigators
¹ Department of Intensive Care and Lab. of Experimental Intensive Care and Anesthesiology (L E I C A), Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
² Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
³ Department of Pulmonology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
⁴ Department of Intensive Care Medicine and CIBER de Enfermedades Respiratorias, Hospital de Sabadell, Corporació Sanitaria I Universitària Parc Taulí, Sabadell, Spain
⁵ Department of Anesthesiology, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain
⁶ Department of Critical Care, Westfriesgasthuis, Hoorn, The Netherlands
⁷ Department of Intensive Care, St Vincent’s Hospital, Melbourne, Australia
⁸ Department of Medical Sciences, Uppsala University, Uppsala, Sweden
⁹ Department of Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands
¹⁰ Medical Intensive Care Unit, Division of General Internal Medicine, University Hospital Leuven, Louvain, Belgium
¹¹ Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Louvain, Belgium
¹² Division of Cardiac, Thoracic, and Vascular Anesthesia and Intensive Care, Medical University Vienna, Vienna, Austria
¹³ Department of Critical Care Medicine and Anesthesiology (SAR B), Saint Eloi University Hospital, Montpellier, France
¹⁴ Department of Clinical Medicine, Trinity Centre for Health Sciences, Multidisciplinary Intensive Care Research Organization (MICRO), Welcome Trust, HRB Clinical Research, St James’s University Hospital Dublin, Dublin, Ireland
¹⁵ Irish Centre for Vascular Biology, Irish Centre for Vascular Biology (ICVB), Dublin, Ireland
¹⁶ Department of Anaesthesia and Critical Care Medicine, Sheffield Teaching Hospital, Sheffield, UK
¹⁷ Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
¹⁸ Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
¹⁹ Department of Biotechnologies and Sciences of Life, Insubria University, Varese, Italy
²⁰ Department of Anaesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany
²¹ Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
²² Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany
²³ Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
²⁴ Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, Technische Universität Dresden, Dresden, Germany
²⁵ Department of Surgical Sciences and Integrated Diagnostics, Ospedale Policlinico per la Oncologia, IRCCS per l’Oncologia, University of Genoa, Genoa, Italy
²⁶ Mahidol Oxford Research Unit (MORU), Mahidol University, Bangkok, Thailand

The PROVE Network investigators
Ary Serpa Neto, Carmen S.V. Barbas, Antonio Artigas-Raventós, Jaume Canet, Rogier M. Determann, Barry Dixon, Goran Hedenstierna, Sabrine N.T. Hemmes, Greet Hermans, Michael Hiesmayr, Markus W. Hollmann, Samir Jaber, Ignacio Martin-Loeches, Gary H. Mills, Rupert M. Pearse, Christian Putensen, Werner Schmid, Paolo Severgnini, Roger Smith, Tanja A. Treschan, Edda M. Tschernko, Marcos F. Vidal Melo, Hermann Wrigge, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J. Schultz, Fabienne D. Simonis

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This study is registered with ClinicalTrials.gov as NCT01868321.

Abstract

Background

The majority of critically ill patients do not suffer from acute respiratory distress syndrome (ARDS). To improve the treatment of these patients, we aimed to identify potentially modifiable factors associated with outcome of these patients.

Methods

The PRoVENT was an international, multicenter, prospective cohort study of consecutive patients under invasive mechanical ventilatory support. A predefined secondary analysis was to examine factors associated with mortality. The primary endpoint was all-cause in-hospital mortality.

Results

935 Patients were included. In-hospital mortality was 21%. Compared to patients who died, patients who survived had a lower risk of ARDS according to the ‘Lung Injury Prediction Score’ and received lower maximum airway pressure ( P_max ), driving pressure (Δ P ), positive end-expiratory pressure, and FiO ₂ levels. Tidal volume size was similar between the groups. Higher P_max was a potentially modifiable ventilatory variable associated with in-hospital mortality in multivariable analyses. Δ P was not independently associated with in-hospital mortality, but reliable values for Δ P were available for 343 patients only. Non-modifiable factors associated with in-hospital mortality were older age, presence of immunosuppression, higher non-pulmonary sequential organ failure assessment scores, lower pulse oximetry readings, higher heart rates, and functional dependence.

Conclusions

Higher P_max was independently associated with higher in-hospital mortality in mechanically ventilated critically ill patients under mechanical ventilatory support for reasons other than ARDS.

Trial Registration ClinicalTrials.gov (NCT01868321).

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Keywords : Mechanical ventilation, Outcome, Mortality, Ventilator settings

Plan

Definitions and calculations

Outcomes

Statistical analysis

Results

Participating centers and patients

Ventilation characteristics

Factors associated with in-hospital mortality

Factors associated with ICU mortality

Driving pressure

Discussion

Conclusion

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Vol 8 - N° 1

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Potentially modifiable respiratory variables contributing to outcome in ICU patients without ARDS: a secondary analysis of PRoVENT - 08/01/26

Abstract

Background

Methods

Results

Conclusions

Plan

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