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
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, DPaw ≥ 15, DPL ≥ 12, plateau PL ≥ 24, and oxygenation stretch index < 10 exhibited lower 60-day survival probability. Directly measured end-expiratory PL ≥ 0 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).
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