Driving pressure is a risk factor for ards in mechanically ventilated subjects without ards

Oriol Roca; Oscar Peñuelas; Alfonso Muriel; Marina García-De-Acilu; César Laborda; Judit Sacanell; Jordi Riera; Konstantinos Raymondos; Bin Du; Arnaud W. Thille; Fernando Ríos; Marco González; Lorenzo Del-Sorbo; Maria Del Carmen Marín; Marco Antonio Soares; Bruno Valle Pinheiro; Nicolas Nin; Salvatore M. Maggiore; Andrew Bersten; Pravin Amin; Nahit Çakar; Gee Young Suh; Fekri Abroug; Manuel Jibaja; Dimitros Matamis; Amine Ali Zeggwagh; Yuda Sutherasan; Antonio Anzueto; Andrés Esteban; Fernando Frutos-Vivar

doi:10.4187/respcare.08587

Driving pressure is a risk factor for ards in mechanically ventilated subjects without ards

Oriol Roca, Oscar Peñuelas, Alfonso Muriel, Marina García-De-Acilu, César Laborda, Judit Sacanell, Jordi Riera, Konstantinos Raymondos, Bin Du, Arnaud W. Thille, Fernando Ríos, Marco González, Lorenzo Del-Sorbo, Maria Del Carmen Marín, Marco Antonio Soares, Bruno Valle Pinheiro, Nicolas Nin, Salvatore M. Maggiore, Andrew Bersten, Pravin AminNahit Çakar, Gee Young Suh, Fekri Abroug, Manuel Jibaja, Dimitros Matamis, Amine Ali Zeggwagh, Yuda Sutherasan, Antonio Anzueto, Andrés Esteban, Fernando Frutos-Vivar

Division of Pulmonary Diseases

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

BACKGROUND: Driving pressure (DP) has been described as a risk factor for mortality in patients with ARDS. However, the role of DP in the outcome of patients without ARDS and on mechanical ventilation has received less attention. Our objective was to evaluate the association between DP on the first day of mechanical ventilation with the development of ARDS. METHODS: This was a post hoc analysis of a multicenter, prospective, observational, international study that included subjects who were on mechanical ventilation for>12 h. Our objective was to evaluate the association between DP on the first day of mechanical ventilation with the development of ARDS. To assess the effect of DP, a logistic regression analysis was performed when adjusting for other potential risk factors. Validation of the results obtained was performed by using a bootstrap method and by repeating the same analyses at day 2. RESULTS: A total of 1,575 subjects were included, of whom 65 (4.1%) developed ARDS. The DP was independently associated with ARDS (odds ratio [OR] 1.12, 95% CI 1.07-1.18 for each cm H2O of DP increase, P<.001). The same results were observed at day 2 (OR 1.14, 95% CI 1.07-1.21; P<.001) and after bootstrap validation (OR 1.13, 95% CI 1.04-1.22; P<.001). When taking the prevalence of ARDS in the lowest quartile of DP (^9 cm H2O) as a reference, the subjects with DP>12-15 cm H₂O and those with DP>15 cm H₂O presented a higher probability of ARDS (OR 3.65, 95% CI 1.32-10.04 [P 5.01] and OR 7.31, 95% CI, 2.89-18.50 [P<.001], respectively). CONCLUSIONS: In the subjects without ARDS, a higher level of DP on the first day of mechanical ventilation was associated with later development of ARDS. (ClinicalTrials.gov registration NCT02731898.).

Original language	English (US)
Pages (from-to)	1505-1513
Number of pages	9
Journal	Respiratory care
Volume	66
Issue number	10
DOIs	https://doi.org/10.4187/respcare.08587
State	Published - Oct 1 2021

Keywords

Acute respiratory distress syndrome
Compliance
Driving pressure
Mechanical power
Mechanical ventilation
Mortality
Ventilator-induced lung injury

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine
Pulmonary and Respiratory Medicine

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10.4187/respcare.08587

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Roca, O., Peñuelas, O., Muriel, A., García-De-Acilu, M., Laborda, C., Sacanell, J., Riera, J., Raymondos, K., Du, B., Thille, A. W., Ríos, F., González, M., Del-Sorbo, L., Del Carmen Marín, M., Soares, M. A., Pinheiro, B. V., Nin, N., Maggiore, S. M., Bersten, A., ... Frutos-Vivar, F. (2021). Driving pressure is a risk factor for ards in mechanically ventilated subjects without ards. Respiratory care, 66(10), 1505-1513. https://doi.org/10.4187/respcare.08587

Roca, O, Peñuelas, O, Muriel, A, García-De-Acilu, M, Laborda, C, Sacanell, J, Riera, J, Raymondos, K, Du, B, Thille, AW, Ríos, F, González, M, Del-Sorbo, L, Del Carmen Marín, M, Soares, MA, Pinheiro, BV, Nin, N, Maggiore, SM, Bersten, A, Amin, P, Çakar, N, Suh, GY, Abroug, F, Jibaja, M, Matamis, D, Zeggwagh, AA, Sutherasan, Y, Anzueto, A, Esteban, A & Frutos-Vivar, F 2021, 'Driving pressure is a risk factor for ards in mechanically ventilated subjects without ards', Respiratory care, vol. 66, no. 10, pp. 1505-1513. https://doi.org/10.4187/respcare.08587

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title = "Driving pressure is a risk factor for ards in mechanically ventilated subjects without ards",

abstract = "BACKGROUND: Driving pressure (DP) has been described as a risk factor for mortality in patients with ARDS. However, the role of DP in the outcome of patients without ARDS and on mechanical ventilation has received less attention. Our objective was to evaluate the association between DP on the first day of mechanical ventilation with the development of ARDS. METHODS: This was a post hoc analysis of a multicenter, prospective, observational, international study that included subjects who were on mechanical ventilation for>12 h. Our objective was to evaluate the association between DP on the first day of mechanical ventilation with the development of ARDS. To assess the effect of DP, a logistic regression analysis was performed when adjusting for other potential risk factors. Validation of the results obtained was performed by using a bootstrap method and by repeating the same analyses at day 2. RESULTS: A total of 1,575 subjects were included, of whom 65 (4.1%) developed ARDS. The DP was independently associated with ARDS (odds ratio [OR] 1.12, 95% CI 1.07-1.18 for each cm H2O of DP increase, P<.001). The same results were observed at day 2 (OR 1.14, 95% CI 1.07-1.21; P<.001) and after bootstrap validation (OR 1.13, 95% CI 1.04-1.22; P<.001). When taking the prevalence of ARDS in the lowest quartile of DP (^9 cm H2O) as a reference, the subjects with DP>12-15 cm H2O and those with DP>15 cm H2O presented a higher probability of ARDS (OR 3.65, 95% CI 1.32-10.04 [P 5.01] and OR 7.31, 95% CI, 2.89-18.50 [P<.001], respectively). CONCLUSIONS: In the subjects without ARDS, a higher level of DP on the first day of mechanical ventilation was associated with later development of ARDS. (ClinicalTrials.gov registration NCT02731898.).",

keywords = "Acute respiratory distress syndrome, Compliance, Driving pressure, Mechanical power, Mechanical ventilation, Mortality, Ventilator-induced lung injury",

author = "Oriol Roca and Oscar Pe{\~n}uelas and Alfonso Muriel and Marina Garc{\'i}a-De-Acilu and C{\'e}sar Laborda and Judit Sacanell and Jordi Riera and Konstantinos Raymondos and Bin Du and Thille, {Arnaud W.} and Fernando R{\'i}os and Marco Gonz{\'a}lez and Lorenzo Del-Sorbo and {Del Carmen Mar{\'i}n}, Maria and Soares, {Marco Antonio} and Pinheiro, {Bruno Valle} and Nicolas Nin and Maggiore, {Salvatore M.} and Andrew Bersten and Pravin Amin and Nahit {\c C}akar and Suh, {Gee Young} and Fekri Abroug and Manuel Jibaja and Dimitros Matamis and Zeggwagh, {Amine Ali} and Yuda Sutherasan and Antonio Anzueto and Andr{\'e}s Esteban and Fernando Frutos-Vivar",

note = "Publisher Copyright: {\textcopyright} 2021 Daedalus Enterprises.",

year = "2021",

month = oct,

day = "1",

doi = "10.4187/respcare.08587",

language = "English (US)",

volume = "66",

pages = "1505--1513",

journal = "Respiratory care",

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publisher = "Daedalus Enterprises Inc.",

number = "10",

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TY - JOUR

T1 - Driving pressure is a risk factor for ards in mechanically ventilated subjects without ards

AU - Roca, Oriol

AU - Peñuelas, Oscar

AU - Muriel, Alfonso

AU - García-De-Acilu, Marina

AU - Laborda, César

AU - Sacanell, Judit

AU - Riera, Jordi

AU - Raymondos, Konstantinos

AU - Du, Bin

AU - Thille, Arnaud W.

AU - Ríos, Fernando

AU - González, Marco

AU - Del-Sorbo, Lorenzo

AU - Del Carmen Marín, Maria

AU - Soares, Marco Antonio

AU - Pinheiro, Bruno Valle

AU - Nin, Nicolas

AU - Maggiore, Salvatore M.

AU - Bersten, Andrew

AU - Amin, Pravin

AU - Çakar, Nahit

AU - Suh, Gee Young

AU - Abroug, Fekri

AU - Jibaja, Manuel

AU - Matamis, Dimitros

AU - Zeggwagh, Amine Ali

AU - Sutherasan, Yuda

AU - Anzueto, Antonio

AU - Esteban, Andrés

AU - Frutos-Vivar, Fernando

PY - 2021/10/1

Y1 - 2021/10/1

N2 - BACKGROUND: Driving pressure (DP) has been described as a risk factor for mortality in patients with ARDS. However, the role of DP in the outcome of patients without ARDS and on mechanical ventilation has received less attention. Our objective was to evaluate the association between DP on the first day of mechanical ventilation with the development of ARDS. METHODS: This was a post hoc analysis of a multicenter, prospective, observational, international study that included subjects who were on mechanical ventilation for>12 h. Our objective was to evaluate the association between DP on the first day of mechanical ventilation with the development of ARDS. To assess the effect of DP, a logistic regression analysis was performed when adjusting for other potential risk factors. Validation of the results obtained was performed by using a bootstrap method and by repeating the same analyses at day 2. RESULTS: A total of 1,575 subjects were included, of whom 65 (4.1%) developed ARDS. The DP was independently associated with ARDS (odds ratio [OR] 1.12, 95% CI 1.07-1.18 for each cm H2O of DP increase, P<.001). The same results were observed at day 2 (OR 1.14, 95% CI 1.07-1.21; P<.001) and after bootstrap validation (OR 1.13, 95% CI 1.04-1.22; P<.001). When taking the prevalence of ARDS in the lowest quartile of DP (^9 cm H2O) as a reference, the subjects with DP>12-15 cm H2O and those with DP>15 cm H2O presented a higher probability of ARDS (OR 3.65, 95% CI 1.32-10.04 [P 5.01] and OR 7.31, 95% CI, 2.89-18.50 [P<.001], respectively). CONCLUSIONS: In the subjects without ARDS, a higher level of DP on the first day of mechanical ventilation was associated with later development of ARDS. (ClinicalTrials.gov registration NCT02731898.).

AB - BACKGROUND: Driving pressure (DP) has been described as a risk factor for mortality in patients with ARDS. However, the role of DP in the outcome of patients without ARDS and on mechanical ventilation has received less attention. Our objective was to evaluate the association between DP on the first day of mechanical ventilation with the development of ARDS. METHODS: This was a post hoc analysis of a multicenter, prospective, observational, international study that included subjects who were on mechanical ventilation for>12 h. Our objective was to evaluate the association between DP on the first day of mechanical ventilation with the development of ARDS. To assess the effect of DP, a logistic regression analysis was performed when adjusting for other potential risk factors. Validation of the results obtained was performed by using a bootstrap method and by repeating the same analyses at day 2. RESULTS: A total of 1,575 subjects were included, of whom 65 (4.1%) developed ARDS. The DP was independently associated with ARDS (odds ratio [OR] 1.12, 95% CI 1.07-1.18 for each cm H2O of DP increase, P<.001). The same results were observed at day 2 (OR 1.14, 95% CI 1.07-1.21; P<.001) and after bootstrap validation (OR 1.13, 95% CI 1.04-1.22; P<.001). When taking the prevalence of ARDS in the lowest quartile of DP (^9 cm H2O) as a reference, the subjects with DP>12-15 cm H2O and those with DP>15 cm H2O presented a higher probability of ARDS (OR 3.65, 95% CI 1.32-10.04 [P 5.01] and OR 7.31, 95% CI, 2.89-18.50 [P<.001], respectively). CONCLUSIONS: In the subjects without ARDS, a higher level of DP on the first day of mechanical ventilation was associated with later development of ARDS. (ClinicalTrials.gov registration NCT02731898.).

KW - Acute respiratory distress syndrome

KW - Compliance

KW - Driving pressure

KW - Mechanical power

KW - Mechanical ventilation

KW - Mortality

KW - Ventilator-induced lung injury

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SN - 0020-1324

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JO - Respiratory care

JF - Respiratory care

IS - 10

ER -

Driving pressure is a risk factor for ards in mechanically ventilated subjects without ards

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