scholarly journals The Association between Mechanical Power and Mortality in Patients with Pneumonia Using Pressure-Targeted Ventilation

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1862
Author(s):  
Huang-Pin Wu ◽  
Chien-Ming Chu ◽  
Li-Pang Chuang ◽  
Shih-Wei Lin ◽  
Shaw-Woei Leu ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Distress Syndrome ◽  
Severe Pneumonia ◽  
Driving Pressure ◽  
Mechanical Power ◽  
Health Evaluation ◽  
Independent Factor ◽  
Ventilator Support ◽  
History Of ◽  
Ventilated Patients

Recent studies have reported that mechanical power (MP) is associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). We aimed to investigate the association between 28-day mortality and MP in patients with severe pneumonia. In total, the data of 313 patients with severe pneumonia were used for analysis. Serial MP was calculated daily for either 21 days or until ventilator support was no longer required. Compared with the non-ARDS group, the ARDS group (106 patients) demonstrated lower age, a higher Acute Physiology and Chronic Health Evaluation II score, lower history of diabetes mellitus, elevated incidences of shock and jaundice, higher MP and driving pressure on Day 1, and more deaths within 28 days. Regression analysis revealed that MP was an independent factor associated with 28-day mortality (odds ratio, 1.048; 95% confidence interval, 1.020–1.077). MP was persistently high in non-survivors and low in survivors among the ARDS group, the non-ARDS group, and all patients. These findings indicate that MP is associated with the 28-day mortality in ventilated patients with severe pneumonia, both in the ARDS and non-ARDS groups. MP had a better predicted value for the 28-day mortality than the driving pressure.

The Association Between Mechanical Power and Mortality in Ventilated Patients with Pneumonia

2020 ◽  
Author(s):  
Huang-Pin Wu ◽  
Chien-Ming Chu ◽  
Li-Pang Chuang ◽  
Shih-Wei Lin ◽  
Shaw-Woei Leu ◽  
...  
Keyword(s):  
Distress Syndrome ◽  
Severe Pneumonia ◽  
Binary Logistic Regression ◽  
Driving Pressure ◽  
Mechanical Power ◽  
Regression Analyses ◽  
Ventilator Support ◽  
History Of ◽  
Group Regression ◽  
Ventilated Patients

Abstract Background: Recent studies reported that mechanical power (MP) has been associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). We aimed to investigate the association between 28-day mortality and MP in patients with severe pneumonia. Methods: In total, 313 patients with severe pneumonia were enrolled. Serial MP was recorded daily for either 21 days or until ventilator support was no longer required. The associations between all variables and 28-day mortality were analyzed using binary logistic regression analyses. Results: The ARDS group (106 patients) demonstrated lower age, higher Acute Physiology and Chronic Health Evaluation II score, lower history of diabetes mellitus, high incidences of shock and jaundice, higher MP and driving pressure on Day 1, and higher death within 28 days than the non-ARDS group. Regression analysis revealed that MP was an independent factor associated with 28-day mortality (odds ratio, 1.041; 95% confidence interval, 1.013-1.071). MP persisted high in non-survivors and low in survivors among the ARDS group, the non-ARDS group and all patients.Conclusions: MP was associated with the 28-day mortality in ventilated patients with severe pneumonia both in the ARDS and non-ARDS groups. MP had better predicted value for 28-day mortality than driving pressure.

scholarly journals Driving Pressure Is Associated with Outcome during Assisted Ventilation in Acute Respiratory Distress Syndrome

2019 ◽  
Vol 131 (3) ◽  
pp. 594-604 ◽  
Author(s):  
Giacomo Bellani ◽  
Alice Grassi ◽  
Simone Sosio ◽  
Stefano Gatti ◽  
Brian P. Kavanagh ◽  
...  
Keyword(s):  
Respiratory System ◽  
Odds Ratio ◽  
Pressure Support ◽  
Distress Syndrome ◽  
Peak Pressure ◽  
Plateau Pressure ◽  
Assisted Ventilation ◽  
Driving Pressure ◽  
Respiratory System Compliance ◽  
Controlled Mechanical Ventilation

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Driving pressure, the difference between plateau pressure and positive end-expiratory pressure (PEEP), is closely associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). Although this relationship has been demonstrated during controlled mechanical ventilation, plateau pressure is often not measured during spontaneous breathing because of concerns about validity. The objective of the present study is to verify whether driving pressure and respiratory system compliance are independently associated with increased mortality during assisted ventilation (i.e., pressure support ventilation). Methods This is a retrospective cohort study conducted on 154 patients with ARDS in whom plateau pressure during the first three days of assisted ventilation was available. Associations between driving pressure, respiratory system compliance, and survival were assessed by univariable and multivariable analysis. In patients who underwent a computed tomography scan (n = 23) during the stage of assisted ventilation, the quantity of aerated lung was compared with respiratory system compliance measured on the same date. Results In contrast to controlled mechanical ventilation, plateau pressure during assisted ventilation was higher than the sum of PEEP and pressure support (peak pressure). Driving pressure was higher (11 [9–14] vs. 10 [8–11] cm H2O; P = 0.004); compliance was lower (40 [30–50] vs. 51 [42–61] ml · cm H2O-1; P < 0.001); and peak pressure was similar, in nonsurvivors versus survivors. Lower respiratory system compliance (odds ratio, 0.92 [0.88–0.96]) and higher driving pressure (odds ratio, 1.34 [1.12–1.61]) were each independently associated with increased risk of death. Respiratory system compliance was correlated with the aerated lung volume (n = 23, r = 0.69, P < 0.0001). Conclusions In patients with ARDS, plateau pressure, driving pressure, and respiratory system compliance can be measured during assisted ventilation, and both higher driving pressure and lower compliance are associated with increased mortality.

scholarly journals A Nomogram to Predict Acute Respiratory Distress Syndrome After Cardiac Surgery

2021 ◽  
Vol 24 (3) ◽  
pp. E445-E450
Author(s):  
Yan Liu ◽  
Man Song ◽  
Lixue Huang ◽  
Guangfa Zhu
Keyword(s):  
Cardiac Surgery ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Odds Ratio ◽  
Distress Syndrome ◽  
Artery Bypass ◽  
Albumin Level ◽  
Internal Validation ◽  
History Of

Purpose: To establish a model to predict the risk of acute respiratory distress syndrome (ARDS) after cardiac surgery. Methods: Data were collected on 132 ARDS patients, who received valvular or coronary artery bypass grafting surgery from January 2009 to December 2019. We developed the prediction model by multivariable logistic regression. Then, we used the coefficients for developing a nomogram that predicts ARDS occurrence. Internal validation was performed using resampling techniques to evaluate and optimize the model. Results: All variables fit into the model, including albumin level before surgery (odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.92, 0.99; P = .01), cardiopulmonary bypass time (OR: 1.01; 95% CI: 1.00, 1.02; P = .02), APACHE II after surgery (OR: 1.21; 95% CI: 1.13, 1.29; P < .001), and history of diabetes (OR: 2.31; 95% CI: 1.88, 3.87; P < .001); these were considered to build the nomogram. The score distinguished ARDS patients from non-ARDS patients with an AUC of 0.785 (95% CI: 0.740, 0.830) and was well calibrated (Hosmer–Lemeshow P = .53). Conclusions: Our developed model predicted ARDS in patients undergoing cardiac surgery and may serve as a tool for identifying patients at high risk for ARDS after cardiac surgery.

scholarly journals Pain Assessment Is Associated with Decreased Duration of Mechanical Ventilation in the Intensive Care Unit

2009 ◽  
Vol 111 (6) ◽  
pp. 1308-1316 ◽  
Author(s):  
Jean-Francois Payen ◽  
Jean-Luc Bosson ◽  
Gérald Chanques ◽  
Jean Mantz ◽  
José Labarere ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Pain Assessment ◽  
Odds Ratio ◽  
Ventilator Support ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Score Analysis ◽  
Adjusted Score ◽  
Ventilated Patients

Background Critically ill patients frequently experience pain, but assessment rates remain below 40% in mechanically ventilated patients. Whether pain assessment affects patient outcomes is largely unknown. Methods As part of a prospective cohort study of mechanically ventilated patients who received analgesia on day 2 of their stay in the intensive care unit (ICU), the investigators performed propensity-adjusted score analysis to compare the duration of ventilator support and duration of ICU stay between 513 patients who were assessed for pain and 631 patients who were not assessed for pain. Results Patients assessed for pain on day 2 were more likely to receive sedation level assessment, nonopioids, and dedicated analgesia during painful procedures than patients whose pain was not assessed. They also received fewer hypnotics and lower daily doses of midazolam. Patients with pain assessment had a shorter duration of mechanical ventilation (8 vs. 11 days; P &lt; 0.01) and a reduced duration of stay in the ICU (13 vs. 18 days; P &lt; 0.01). In propensity-adjusted score analysis, pain assessment was associated with increased odds of weaning from the ventilator (odds ratio, 1.40; 95% confidence interval, 1.00-1.98) and of discharge from the ICU (odds ratio, 1.43; 95% confidence interval, 1.02-2.00). Conclusions Pain assessment in mechanically ventilated patients is independently associated with a reduction in the duration of ventilator support and of duration of ICU stay. This might be related to higher concomitant rates of sedation assessments and a restricted use of hypnotic drugs when pain is assessed.

scholarly journals Severe Lymphopenia as a Predictor of COVID-19 Mortality in Immunosuppressed Patients

2021 ◽  
Vol 10 (16) ◽  
pp. 3595
Author(s):  
María Martínez-Urbistondo ◽  
Ángela Gutiérrez-Rojas ◽  
Ane Andrés ◽  
Isabel Gutiérrez ◽  
Gabriela Escudero ◽  
...  
Keyword(s):  
High Mortality ◽  
Odds Ratio ◽  
Distress Syndrome ◽  
Mortality Rates ◽  
Tertiary Hospital ◽  
Immunocompromised Patients ◽  
Independent Factor ◽  
Immunosuppressed Patients ◽  
The Impact

Background. Coronavirus disease 2019 (COVID-19) has a high mortality in certain group of patients. We analysed the impact of baseline immunosuppression in COVID-19 mortality and the role of severe lymphopenia in immunocompromised subjects. Methods. We analysed all patients admitted with COVID-19 in a tertiary hospital in Madrid between March 1st and April 30th 2020. Epidemiological and clinical data, including severe lymphopenia (<500 lymphocytes/mm3) during admission, were analysed and compared based on their baseline immunosuppression condition. Results. A total of 1594 patients with COVID-19 pneumonia were hospitalised during the study period. 166 (10.4%) were immunosuppressed. Immunocompromised patients were younger (64 vs. 67 years, p = 0.02) but presented higher rates of hypertension, diabetes, heart, neurological, lung, kidney and liver disease (p < 0.05). They showed more severe lymphopenia (53% vs 24.1%, p < 0.001), lower SapO2/FiO2 ratios (251 vs 276, p = 0.02) during admission and higher mortality rates (27.1% vs 13.5%, p < 0.001). After adjustment, immunosuppression remained as an independent factor related to mortality (Odds Ratio (OR): 2.24, p < 0.001). In the immunosuppressed group, age (OR = 1.06, p = 0.01), acute respiratory distress syndrome (ARDS) (OR = 12.27, p = 0.017) and severe lymphopenia (OR = 3.48, p = 0.04) were the factors related to high mortality rate. Conclusion. Immunosuppression is an independent mortality risk factor in COVID-19. Severe lymphopenia should be promptly identified in these patients.

Association of Driving Pressure With Mortality Among Ventilated Patients With Acute Respiratory Distress Syndrome

2018 ◽  
Vol 46 (2) ◽  
pp. 300-306 ◽  
Author(s):  
Hiroko Aoyama ◽  
Tommaso Pettenuzzo ◽  
Kazuyoshi Aoyama ◽  
Ruxandra Pinto ◽  
Marina Englesakis ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Driving Pressure ◽  
Ventilated Patients

scholarly journals Decision support system to evaluate VENTilation in the Acute Respiratory Distress Syndrome (DeVENT study): Trial Protocol

2021 ◽  
Author(s):  
Brijesh V Patel ◽  
Sharon Mumby ◽  
Nicholas Johnson ◽  
Emanuela Falaschetti ◽  
Jorgen Hansen ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Decision Support ◽  
Lung Injury ◽  
Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Driving Pressure ◽  
Ventilator Induced Lung Injury ◽  
Ventilated Patients

Background: The Acute Respiratory Distress Syndrome (ARDS) occurs in response to a variety of insults, and mechanical ventilation is life-saving in this setting, but ventilator induced lung injury can also contribute to the morbidity and mortality in the condition. The Beacon Caresystem is a model-based bedside decision support system using mathematical models tuned to the individual patient's physiology to advise on appropriate ventilator settings. Personalised approaches using individual patient description may be particularly advantageous in complex patients, including those who are difficult to mechanically ventilate and wean, in particular ARDS. Methods: We will conduct a multi-centre international randomised, controlled, allocation concealed, open, pragmatic clinical trial to compare mechanical ventilation in ARDS patients following application of the Beacon Caresystem to that of standard routine care to investigate whether use of the system results in a reduction in driving pressure across all severities and phases of ARDS. Discussion. Despite 20 years of clinical trial data showing significant improvements in ARDS mortality through mitigation of ventilator induced lung injury, there remains a gap in its personalised application at the bedside. Importantly, the protective effects of higher positive end-expiratory pressure (PEEP) were noted only when there were associated decreases in driving pressure. Hence, the pressures set on the ventilator should be determined by the diseased lungs' pressure-volume relationship which is often unknown or difficult to determine. Knowledge of extent of recruitable lung could improve the ventilator driving pressure. Hence, personalised management demands the application of mechanical ventilation according to the physiological state of the diseased lung at that time. Hence, there is significant rationale for the development of point-of-care clinical decision support systems which help personalise ventilatory strategy according to the current physiology. Furthermore, the potential for the application of the Beacon Caresystem to facilitate local and remote management of large numbers of ventilated patients (as seen during this COVID-19 pandemic), could change the outcome of mechanically ventilated patients during the course of this and future pandemics. Trial registration: ClinicalTrials.gov identifier (NCT number): NCT04115709

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