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Driving Pressure and Survival in the Acute Respiratory Distress Syndrome
- Source :
- New England Journal of Medicine. 372:747-755
- Publication Year :
- 2015
- Publisher :
- Massachusetts Medical Society, 2015.
-
Abstract
- BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size), we hypothesized that driving pressure (ΔP = V T /C RS ), in which V T is intrinsically normalized to functional lung size (instead of predicted lung size in healthy persons), would be an index more strongly associated with survival than V T or PEEP in patients who are not actively breathing. METHODS Using a statistical tool known as multilevel mediation analysis to analyze individual data from 3562 patients with ARDS enrolled in nine previously reported randomized trials, we examined ΔP as an independent variable associated with survival. In the mediation analysis, we estimated the isolated effects of changes in ΔP resulting from randomized ventilator settings while minimizing confounding due to the baseline severity of lung disease. RESULTS Among ventilation variables, ΔP was most strongly associated with survival. A 1-SD increment in ΔP (approximately 7 cm of water) was associated with increased mortality (relative risk, 1.41; 95% confidence interval [CI], 1.31 to 1.51; P
- Subjects :
- Risk
medicine.medical_specialty
ARDS
Pulmonary compliance
Positive-Pressure Respiration
Plateau pressure
Internal medicine
Pressure
Tidal Volume
medicine
Humans
Lung
Lung Compliance
Tidal volume
Proportional Hazards Models
Respiratory Distress Syndrome
business.industry
Proportional hazards model
Confounding
General Medicine
Prognosis
medicine.disease
Confidence interval
Surgery
Multivariate Analysis
Cardiology
Breathing
business
Subjects
Details
- ISSN :
- 15334406 and 00284793
- Volume :
- 372
- Database :
- OpenAIRE
- Journal :
- New England Journal of Medicine
- Accession number :
- edsair.doi.dedup.....7635fb51e84be9e5ad96e868f1171c56