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Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS
- Source :
- Chest, Chest, American College of Chest Physicians, 2020, 158 (5), pp.1947-1957. ⟨10.1016/j.chest.2020.05.602⟩
- Publication Year :
- 2020
- Publisher :
- HAL CCSD, 2020.
-
Abstract
- International audience; Background: In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement.Research question: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [ΔPrs]).Study design and methods: This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, ΔPrs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality.Results: Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.01-2.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher ΔPrs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: ΔPrs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality.Interpretation: In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.
- Subjects :
- Pulmonary and Respiratory Medicine
ARDS
medicine.medical_specialty
MESH: Respiratory Distress Syndrome
medicine.medical_treatment
Population
Respiratory physiology
Neutropenia
Critical Care and Intensive Care Medicine
Acute respiratory failure
MESH: Tidal Volume
[SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract
MESH: Prognosis
03 medical and health sciences
MESH: Positive-Pressure Respiration
0302 clinical medicine
Diagnosis
medicine
MESH: Immunocompromised Host
Renal replacement therapy
education
Immunocompromised
Tidal volume
Outcome
MESH: Aged
education.field_of_study
MESH: Humans
MESH: Middle Aged
business.industry
Mortality rate
030208 emergency & critical care medicine
MESH: Follow-Up Studies
Plateau pressure
medicine.disease
MESH: Male
MESH: Prospective Studies
3. Good health
030228 respiratory system
Emergency medicine
Driving pressure
Etiology
MESH: Respiratory Mechanics
Cardiology and Cardiovascular Medicine
business
MESH: Female
Subjects
Details
- Language :
- English
- ISSN :
- 00123692
- Database :
- OpenAIRE
- Journal :
- Chest, Chest, American College of Chest Physicians, 2020, 158 (5), pp.1947-1957. ⟨10.1016/j.chest.2020.05.602⟩
- Accession number :
- edsair.doi.dedup.....49aa3e34eb33dc3b480d0699ef3acc7f