xlung

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 7^th 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 (DP_L) is a better predictor of outcome than DP_aw.

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

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

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

DP_aw had the best-fit Cox regression model.

When dichotomizing the variables, DP_aw ≥ 15, DP_L ≥ 12, plateau P_L ≥ 24, and oxygenation stretch index < 10 exhibited lower 60-day survival probability. Directly measured end-expiratory P_L ≥ 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).

Let’s learn together!