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Effect of Lowering Vt on Mortality in Acute Respiratory Distress Syndrome Varies with Respiratory System Elastance.
Goligher, Ewan C; Costa, Eduardo L V; Yarnell, Christopher J; Brochard, Laurent J; Stewart, Thomas E; Tomlinson, George; Brower, Roy G; Slutsky, Arthur S; Amato, Marcelo P B.
Afiliación
  • Goligher EC; Interdepartmental Division of Critical Care Medicine.
  • Costa ELV; Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada.
  • Yarnell CJ; Toronto General Hospital Research Institute, Toronto General Hospital, Toronto, Ontario, Canada.
  • Brochard LJ; Laboratório de Pneumologia LIM-09, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil.
  • Stewart TE; Research and Education Institute, Hospital Sírio-Libanes, São Paulo, Brazil.
  • Tomlinson G; Interdepartmental Division of Critical Care Medicine.
  • Brower RG; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
  • Slutsky AS; Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada.
  • Amato MPB; Interdepartmental Division of Critical Care Medicine.
Am J Respir Crit Care Med ; 203(11): 1378-1385, 2021 06 01.
Article en En | MEDLINE | ID: mdl-33439781
Rationale: If the risk of ventilator-induced lung injury in acute respiratory distress syndrome (ARDS) is causally determined by driving pressure rather than by Vt, then the effect of ventilation with lower Vt on mortality would be predicted to vary according to respiratory system elastance (Ers). Objectives: To determine whether the mortality benefit of ventilation with lower Vt varies according to Ers. Methods: In a secondary analysis of patients from five randomized trials of lower- versus higher-Vt ventilation strategies in ARDS and acute hypoxemic respiratory failure, the posterior probability of an interaction between the randomized Vt strategy and Ers on 60-day mortality was computed using Bayesian multivariable logistic regression. Measurements and Main Results: Of 1,096 patients available for analysis, 416 (38%) died by Day 60. The posterior probability that the mortality benefit from lower-Vt ventilation strategies varied with Ers was 93% (posterior median interaction odds ratio, 0.80 per cm H2O/[ml/kg]; 90% credible interval, 0.63-1.02). Ers was classified as low (<2 cm H2O/[ml/kg], n = 321, 32%), intermediate (2-3 cm H2O/[ml/kg], n = 475, 46%), and high (>3 cm H2O/[ml/kg], n = 224, 22%). In these groups, the posterior probabilities of an absolute risk reduction in mortality ≥ 1% were 55%, 82%, and 92%, respectively. The posterior probabilities of an absolute risk reduction ≥ 5% were 29%, 58%, and 82%, respectively. Conclusions: The mortality benefit of ventilation with lower Vt in ARDS varies according to elastance, suggesting that lung-protective ventilation strategies should primarily target driving pressure rather than Vt.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Respiración Artificial / Síndrome de Dificultad Respiratoria / Resistencia de las Vías Respiratorias Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male Idioma: En Revista: Am J Respir Crit Care Med Asunto de la revista: TERAPIA INTENSIVA Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Respiración Artificial / Síndrome de Dificultad Respiratoria / Resistencia de las Vías Respiratorias Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male Idioma: En Revista: Am J Respir Crit Care Med Asunto de la revista: TERAPIA INTENSIVA Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos