Impact of the Driving Pressure on Mortality in Obese and Non-obese ARDS Patients: a Retrospective Study of 362 Cases

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2018 Jun 28

PMID 29947888

Citations 40

Authors

Audrey De Jong

Jeanne Cossic

Daniel Verzilli

Clement Monet

Julie Carr

Mathieu Conseil

Marion Monnin

Moussa Cisse

Fouad Belafia

Nicolas Molinari

Gerald Chanques

Samir Jaber

Affiliations

Soon will be listed here.

Abstract

Purpose: The relation between driving pressure (plateau pressure-positive end-expiratory pressure) and mortality has never been studied in obese ARDS patients. The main objective of this study was to evaluate the relationship between 90-day mortality and driving pressure in an ARDS population ventilated in the intensive care unit (ICU) according to obesity status.

Methods: We conducted a retrospective single-center study of prospectively collected data of all ARDS patients admitted consecutively to a mixed medical-surgical adult ICU from January 2009 to May 2017. Plateau pressure, compliance of the respiratory system (Crs) and driving pressure of the respiratory system within 24 h of ARDS diagnosis were compared between survivors and non-survivors at day 90 and between obese (body mass index ≥ 30 kg/m) and non-obese patients. Cox proportional hazard modeling was used for mortality at day 90.

Results: Three hundred sixty-two ARDS patients were included, 262 (72%) non-obese and 100 (28%) obese patients. Mortality rate at day 90 was respectively 47% (95% CI, 40-53) in the non-obese and 46% (95% CI, 36-56) in the obese patients. Driving pressure at day 1 in the non-obese patients was significantly lower in survivors at day 90 (11.9 ± 4.2 cmHO) than in non-survivors (15.2 ± 5.2 cmHO, p < 0.001). Contrarily, in obese patients, driving pressure at day 1 was not significantly different between survivors (13.7 ± 4.5 cmHO) and non-survivors (13.2 ± 5.1 cmHO, p = 0.41) at day 90. After three multivariate Cox analyses, plateau pressure [HR = 1.04 (95% CI 1.01-1.07) for each point of increase], Crs [HR = 0.97 (95% CI 0.96-0.99) for each point of increase] and driving pressure [HR = 1.07 (95% CI 1.04-1.10) for each point of increase], respectively, were independently associated with 90-day mortality in non-obese patients, but not in obese patients.

Conclusions: Contrary to non-obese ARDS patients, driving pressure was not associated with mortality in obese ARDS patients.

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References

Eichler L, Truskowska K, Dupree A, Busch P, Goetz A, Zollner C . Intraoperative Ventilation of Morbidly Obese Patients Guided by Transpulmonary Pressure. Obes Surg. 2017; 28(1):122-129. DOI: 10.1007/s11695-017-2794-3. View

Constantin J, Jaber S . [Preoxygenation in obese patient with non-invasive pressure support ventilation: keep the pressure!]. Ann Fr Anesth Reanim. 2012; 31(9):673-4. DOI: 10.1016/j.annfar.2012.07.002. View

Pepin J, Timsit J, Tamisier R, Borel J, Levy P, Jaber S . Prevention and care of respiratory failure in obese patients. Lancet Respir Med. 2016; 4(5):407-18. DOI: 10.1016/S2213-2600(16)00054-0. View

Pirrone M, Fisher D, Chipman D, Imber D, Corona J, Mietto C . Recruitment Maneuvers and Positive End-Expiratory Pressure Titration in Morbidly Obese ICU Patients. Crit Care Med. 2015; 44(2):300-7. DOI: 10.1097/CCM.0000000000001387. View

Anzueto A, Frutos-Vivar F, Esteban A, Bensalami N, Marks D, Raymondos K . Influence of body mass index on outcome of the mechanically ventilated patients. Thorax. 2010; 66(1):66-73. DOI: 10.1136/thx.2010.145086. View

De Jong A, Deras P, Martinez O, Latry P, Jaber S, Capdevila X . Relationship between Obesity and Massive Transfusion Needs in Trauma Patients, and Validation of TASH Score in Obese Population: A Retrospective Study on 910 Trauma Patients. PLoS One. 2016; 11(3):e0152109. PMC: 4807035. DOI: 10.1371/journal.pone.0152109. View

Ranieri V, Rubenfeld G, Thompson B, Ferguson N, Caldwell E, Fan E . Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012; 307(23):2526-33. DOI: 10.1001/jama.2012.5669. View

Amato M, Meade M, Slutsky A, Brochard L, Costa E, Schoenfeld D . Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015; 372(8):747-55. DOI: 10.1056/NEJMsa1410639. View

Guerin C, Reignier J, Richard J, Beuret P, Gacouin A, Boulain T . Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013; 368(23):2159-68. DOI: 10.1056/NEJMoa1214103. View

10.

De Jong A, Carreira S, Na N, Carillion A, Jiang C, Beuvin M . Diaphragmatic function is enhanced in fatty and diabetic fatty rats. PLoS One. 2017; 12(3):e0174043. PMC: 5362060. DOI: 10.1371/journal.pone.0174043. View

11.

Delay J, Sebbane M, Jung B, Nocca D, Verzilli D, Pouzeratte Y . The effectiveness of noninvasive positive pressure ventilation to enhance preoxygenation in morbidly obese patients: a randomized controlled study. Anesth Analg. 2008; 107(5):1707-13. DOI: 10.1213/ane.0b013e318183909b. View

12.

. Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Arch Intern Med. 1998; 158(17):1855-67. DOI: 10.1001/archinte.158.17.1855. View

13.

Gong M, Bajwa E, Thompson B, Christiani D . Body mass index is associated with the development of acute respiratory distress syndrome. Thorax. 2009; 65(1):44-50. PMC: 3090260. DOI: 10.1136/thx.2009.117572. View

14.

Mahul M, Jung B, Galia F, Molinari N, De Jong A, Coisel Y . Spontaneous breathing trial and post-extubation work of breathing in morbidly obese critically ill patients. Crit Care. 2016; 20(1):346. PMC: 5081985. DOI: 10.1186/s13054-016-1457-4. View

15.

Jabaudon M, Godet T, Futier E, Bazin J, Sapin V, Roszyk L . Rationale, study design and analysis plan of the lung imaging morphology for ventilator settings in acute respiratory distress syndrome study (LIVE study): Study protocol for a randomised controlled trial. Anaesth Crit Care Pain Med. 2017; 36(5):301-306. DOI: 10.1016/j.accpm.2017.02.006. View

16.

Baedorf Kassis E, Loring S, Talmor D . Mortality and pulmonary mechanics in relation to respiratory system and transpulmonary driving pressures in ARDS. Intensive Care Med. 2016; 42(8):1206-13. DOI: 10.1007/s00134-016-4403-7. View

17.

Villar J, Martin-Rodriguez C, Dominguez-Berrot A, Fernandez L, Ferrando C, Soler J . A Quantile Analysis of Plateau and Driving Pressures: Effects on Mortality in Patients With Acute Respiratory Distress Syndrome Receiving Lung-Protective Ventilation. Crit Care Med. 2017; 45(5):843-850. DOI: 10.1097/CCM.0000000000002330. View

18.

Fumagalli J, Berra L, Zhang C, Pirrone M, De Santis Santiago R, Gomes S . Transpulmonary Pressure Describes Lung Morphology During Decremental Positive End-Expiratory Pressure Trials in Obesity. Crit Care Med. 2017; 45(8):1374-1381. DOI: 10.1097/CCM.0000000000002460. View

19.

Mafort T, Rufino R, Henrique Costa C, Lopes A . Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function. Multidiscip Respir Med. 2016; 11:28. PMC: 4940831. DOI: 10.1186/s40248-016-0066-z. View

20.

Bellani G, Laffey J, Pham T, Fan E, Brochard L, Esteban A . Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA. 2016; 315(8):788-800. DOI: 10.1001/jama.2016.0291. View