1. A lung rescue team improves survival in obesity with acute respiratory distress syndrome
- Author
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Florio, Gaetano, Ferrari, Matteo, Bittner, Edward A, De Santis Santiago, Roberta, Pirrone, Massimiliano, Fumagalli, Jacopo, Teggia Droghi, Maddalena, Mietto, Cristina, Pinciroli, Riccardo, Berg, Sheri, Bagchi, Aranya, Shelton, Kenneth, Kuo, Alexander, Lai, Yvonne, Sonny, Abraham, Lai, Peggy, Hibbert, Kathryn, Kwo, Jean, Pino, Richard M, Wiener-Kronish, Jeanine, Amato, Marcelo BP, Arora, Pankaj, Kacmarek, Robert M, and Berra, Lorenzo
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Rare Diseases ,Clinical Research ,Lung ,Bioengineering ,Assistive Technology ,Clinical Trials and Supportive Activities ,Obesity ,Acute Respiratory Distress Syndrome ,Respiratory ,Good Health and Well Being ,APACHE ,Adult ,Aged ,Body Mass Index ,Cohort Studies ,Female ,Humans ,Intensive Care Units ,Male ,Middle Aged ,Respiration ,Artificial ,Respiratory Distress Syndrome ,Retrospective Studies ,ARDS ,Mechanical ventilation ,Cardiopulmonary physiology ,Mortality ,investigators of the lung rescue team ,Medical and Health Sciences ,Emergency & Critical Care Medicine ,Biomedical and clinical sciences ,Health sciences - Abstract
BackgroundLimited data exist regarding ventilation in patients with class III obesity [body mass index (BMI) > 40 kg/m2] and acute respiratory distress syndrome (ARDS). The aim of the present study was to determine whether an individualized titration of mechanical ventilation according to cardiopulmonary physiology reduces the mortality in patients with class III obesity and ARDS.MethodsIn this retrospective study, we enrolled adults admitted to the ICU from 2012 to 2017 who had class III obesity and ARDS and received mechanical ventilation for > 48 h. Enrolled patients were divided in two cohorts: one cohort (2012-2014) had ventilator settings determined by the ARDSnet table for lower positive end-expiratory pressure/higher inspiratory fraction of oxygen (standard protocol-based cohort); the other cohort (2015-2017) had ventilator settings determined by an individualized protocol established by a lung rescue team (lung rescue team cohort). The lung rescue team used lung recruitment maneuvers, esophageal manometry, and hemodynamic monitoring.ResultsThe standard protocol-based cohort included 70 patients (BMI = 49 ± 9 kg/m2), and the lung rescue team cohort included 50 patients (BMI = 54 ± 13 kg/m2). Patients in the standard protocol-based cohort compared to lung rescue team cohort had almost double the risk of dying at 28 days [31% versus 16%, P = 0.012; hazard ratio (HR) 0.32; 95% confidence interval (CI95%) 0.13-0.78] and 3 months (41% versus 22%, P = 0.006; HR 0.35; CI95% 0.16-0.74), and this effect persisted at 6 months and 1 year (incidence of death unchanged 41% versus 22%, P = 0.006; HR 0.35; CI95% 0.16-0.74).ConclusionIndividualized titration of mechanical ventilation by a lung rescue team was associated with decreased mortality compared to use of an ARDSnet table.
- Published
- 2020