by Sahetya, Sarina K.; Wu, T. David; Morgan, Brooks;
Herrera, Phabiola; Roldan, Rollin; Paz, Enrique; Jaymez, Amador A.; Chirinos,
Eduardo; Portugal, Jose; Quispe, Rocio; Brower, Roy G.; Checkley, William;
Capanni, Francesca; Caravedo, Maria A.; Cerna, Jorge; Davalos, Long; De Ferrari,
Aldo; Denney, Joshua A.; Dulanto, Augusto; Mongilardi, Nicole; Paredes, Carmen;
Pereda, Maria Alejandra; Shams, Navid; INTENSIVOS Cohort StudyThe INTENSIVOS
Cohort Study are as follows
Critical Care Medicine: May 2020 -
Volume 48 - Issue 5 - p 688-695
Objectives: To
determine the association between mean airway pressure and 90-day mortality in
patients with acute respiratory failure requiring mechanical ventilation and to
compare the predictive ability of mean airway pressure compared with
inspiratory plateau pressure and driving pressure.
Design:
Prospective observational cohort.
Setting: Five
ICUs in Lima, Peru. Subjects: Adults requiring invasive mechanical ventilation
via endotracheal tube for acute respiratory failure. Interventions: None.
Measurements and Main
Results: Of potentially eligible participants (n = 1,500), 65 (4%) were
missing baseline mean airway pressure, while 352 (23.5%) were missing baseline
plateau pressure and driving pressure. Ultimately, 1,429 participants were
included in the analysis with an average age of 59 ± 19 years, 45% female, and
a mean Pao2/Fio2 ratio of 248 ± 147 mm Hg at baseline. Overall, 90-day
mortality was 50.4%. Median baseline mean airway pressure was 13 cm H2O
(interquartile range, 10–16 cm H2O) in participants who died compared to a
median mean airway pressure of 12 cm H2O (interquartile range, 10–14 cm H2O) in
participants who survived greater than 90 days (p < 0.001). Mean airway
pressure was independently associated with 90-day mortality (odds ratio, 1.38
for difference comparing the 75th to the 25th percentile for mean airway
pressure; 95% CI, 1.10–1.74) after adjusting for age, sex, baseline Acute
Physiology and Chronic Health Evaluation III, baseline Pao2/Fio2 (modeled with
restricted cubic spline), baseline positive end-expiratory pressure, baseline
tidal volume, and hospital site. In predicting 90-day mortality, baseline mean
airway pressure demonstrated similar discriminative ability (adjusted area
under the curve = 0.69) and calibration characteristics as baseline plateau
pressure and driving pressure.
Conclusions: In a
multicenter prospective cohort, baseline mean airway pressure was independently
associated with 90-day mortality in mechanically ventilated participants and
predicts mortality similarly to plateau pressure and driving pressure. Because
mean airway pressure is readily available on all mechanically ventilated
patients and all ventilator modes, it is a potentially more useful predictor of
mortality in acute respiratory failure.
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