Discussion Forum

 

JOURNAL CLUB - Partition of respiratory mechanics in patients with acute respiratory distress syndrome and association with outcome: a multicentre clinical study.

By: Marcelo Alcantara, Médico - 06/14/2022 21:10

Hi Xlungers,

This week the original paper in our Journal Club has Chen L as the first author and a team of outstanding investigators Laurent Brochard as the last author published in Intensive Care Medicine on the 7th of June, 2022.

It describes a multicentre study to examine the relative importance of the global and partitioned respiratory mechanics in the outcome of ARDS patients.

 

The main hypothesis was that transpulmonary driving pressure (DPL) is a better predictor of outcome than DPaw.

The secondary hypothesis was that oxygenation stretch index, a composite variable using PaO2/FiO2 divided by DPaw, can enhance the predictive power of DPaw.

 

Three hundred eighty-five patients were enrolled two days from intubation.

 

As continuous variables, DPaw, DPL, and oxygenation stretch index were associated with 60-day mortality after adjustment for age and SOFA score.

 

DPaw had the best-fit Cox regression model.

 

When dichotomizing the variables, DPaw15, DPL12, plateau PL24, and oxygenation stretch index<10 exhibited lower 60-day survival probability. Directly measured end-expiratory PL0 was associated with better outcome in obese patients.

Check the figure below from the paper.

Does this article reinforce the value of the driving pressure measured in the airway as a strong predictor of mortality in ARDS?

Should we add PaO2/FIO2 to the driving pressure to better predict ARDS outcomes?

Link to the paper:

Chen, L., Grieco, D.L., Beloncle, F. et al. Partition of respiratory mechanics in patients with acute respiratory distress syndrome and association with outcome: a multicentre clinical study. Intensive Care Med (2022).

Let’s learn together!



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