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A lung rescue team improves survival in obesity with acute respiratory distress syndrome.
Florio, Gaetano; Ferrari, Matteo; Bittner, Edward A; De Santis Santiago, Roberta; Pirrone, Massimiliano; Fumagalli, Jacopo; Teggia Droghi, Maddalena; Mietto, Cristina; Pinciroli, Riccardo; Berg, Sheri; Bagchi, Aranya; Shelton, Kenneth; Kuo, Alexander; Lai, Yvonne; Sonny, Abraham; Lai, Peggy; Hibbert, Kathryn; Kwo, Jean; Pino, Richard M; Wiener-Kronish, Jeanine; Amato, Marcelo B P; Arora, Pankaj; Kacmarek, Robert M; Berra, Lorenzo.
Afiliação
  • Florio G; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Ferrari M; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Bittner EA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • De Santis Santiago R; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Pirrone M; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Fumagalli J; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Teggia Droghi M; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Mietto C; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Pinciroli R; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Berg S; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Bagchi A; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Shelton K; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Kuo A; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Lai Y; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Sonny A; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Lai P; Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA.
  • Hibbert K; Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA.
  • Kwo J; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Pino RM; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Wiener-Kronish J; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Amato MBP; Pulmonary Division, Cardio-Pulmonary Department, Heart Institute (Incor), Hospital Das Clinicas da FMUSP, University of Sao Paulo, Sao Paulo, Brazil.
  • Arora P; Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
  • Kacmarek RM; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02141, USA.
  • Berra L; Department of Respiratory Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Crit Care ; 24(1): 4, 2020 01 15.
Article em En | MEDLINE | ID: mdl-31937345
ABSTRACT

BACKGROUND:

Limited data exist regarding ventilation in patients with class III obesity [body mass index (BMI) > 40 kg/m2] and acute respiratory distress syndrome (ARDS). The aim of the present study was to determine whether an individualized titration of mechanical ventilation according to cardiopulmonary physiology reduces the mortality in patients with class III obesity and ARDS.

METHODS:

In this retrospective study, we enrolled adults admitted to the ICU from 2012 to 2017 who had class III obesity and ARDS and received mechanical ventilation for > 48 h. Enrolled patients were divided in two cohorts one cohort (2012-2014) had ventilator settings determined by the ARDSnet table for lower positive end-expiratory pressure/higher inspiratory fraction of oxygen (standard protocol-based cohort); the other cohort (2015-2017) had ventilator settings determined by an individualized protocol established by a lung rescue team (lung rescue team cohort). The lung rescue team used lung recruitment maneuvers, esophageal manometry, and hemodynamic monitoring.

RESULTS:

The standard protocol-based cohort included 70 patients (BMI = 49 ± 9 kg/m2), and the lung rescue team cohort included 50 patients (BMI = 54 ± 13 kg/m2). Patients in the standard protocol-based cohort compared to lung rescue team cohort had almost double the risk of dying at 28 days [31% versus 16%, P = 0.012; hazard ratio (HR) 0.32; 95% confidence interval (CI95%) 0.13-0.78] and 3 months (41% versus 22%, P = 0.006; HR 0.35; CI95% 0.16-0.74), and this effect persisted at 6 months and 1 year (incidence of death unchanged 41% versus 22%, P = 0.006; HR 0.35; CI95% 0.16-0.74).

CONCLUSION:

Individualized titration of mechanical ventilation by a lung rescue team was associated with decreased mortality compared to use of an ARDSnet table.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Síndrome do Desconforto Respiratório / Obesidade Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Crit Care Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Estados Unidos
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Síndrome do Desconforto Respiratório / Obesidade Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Crit Care Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Estados Unidos