Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS
- Type de publi. : Article dans une revue
- Date de publi. : 01/11/2020
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Auteurs :
Alexandre DemouleMassimo AntonelliPeter SchellongowskiPeter PickkersMarcio SoaresTine MeyhoffJordi RelloPhilippe BauerAndry van de LouwVirgine LemialeDavid GrimaldiIgnacio Martin-LoechesMartin BalikSangeeta MehtaAchille KouatchetAndreas Barratt-DueMiia ValkonenJean ReignierVictoria MetaxaAnne-Sophie MoreauGaston BurghiDjamel MokartJulien MayauxMichaël DarmonÉlie AzoulayKarin AmreinPeter SchellongowskiThomas StaundingerGottfried HeinzGürkan SengölgeChristian ZaunerPeter JakschFabio TacconeDavid GrimaldiAnne Pascale MeertDominique BenoîtUlysses V.A. SilvaAna Paula Pierre de MoraesThiago LishoaMarcio SoaresJorge SalluhWilliam VianaGuilliana MoralezThiago Domingos CorreaSangeeta MehtaUmesh ShahThomas KarvunidisBalik MartinKaterina RussinovaAnders PernerTine Sylvest MeyhoffNielsen JonasRamin Brandt BukanAnn MoellerLene NielsenAchille KouatchetAmélie SeguinAkli ChermakNicolas TerziIsabelle VinatierAnne-Sophie MoreauFlorent WalletDjamel MokartKada KloucheLaura PlatonBenjamin GaboritFrançois BarbierFrederic PèneAntoine RabbatAlexandre DemouleJulien MayauxElie AzoulayVirginie LemialeMartine N'YungaChristophe GiraultCaroline LemaitreElise Artaud-MacariMichael DarmonF. BruneelAnne Sophie MoreauMiia ValkonenAnne KuitunenBrian MarshMater MisericordiaIgnacio Martin-LoechesAisling Mc MahonGilda CinnellaAntonella CotoiaOspedali RiunitiMassimo AntonelliLucas MontiniAngélique Spoelstra de ManPrecious Pearl LandburgDennis BergmansPeter PickkersPleun HemelaarThomas KaufmannAndreas Barrat-DuePål KlepstadJordi RelloBelen EncinaGabriel MorenoLlorenç Socias CrespiEmilio Rodriguez-RuizVictoria MetaxaGaston BurghiAndry van de LouwPhilippe BauerYadav Hemang
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Organismes :
- Publié dans Chest le 29/10/2020
Résumé : Background: In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement. Research question: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [ΔPrs]). Study design and methods: This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, ΔPrs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality. Results: Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.01-2.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher ΔPrs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: ΔPrs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality. Interpretation: In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.
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