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Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study

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@article{3b5a475c24f0496fabd4017391a73bd4,
title = "Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study",
abstract = "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.",
author = "Alexandre Demoule and Massimo Antonelli and Peter Schellongowski and Peter Pickkers and Marcio Soares and Tine Meyhoff and Jordi Rello and Bauer, {Philippe R} and {van de Louw}, Andry and Virgine Lemiale and David Grimaldi and Ignacio Martin-Loeches and Martin Balik and Sangeeta Mehta and Achille Kouatchet and Andreas Barratt-Due and Miia Valkonen and Jean Reignier and Victoria Metaxa and Anne-Sophie Moreau and Gaston Burghi and Djamel Mokart and Julien Mayaux and Michael Darmon and Elie Azoulay and {EFRAIM Investigators}",
note = "Copyright {\textcopyright} 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.",
year = "2020",
month = nov,
doi = "10.1016/j.chest.2020.05.602",
language = "English",
volume = "158",
pages = "1947--1957",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "5",

}

RIS

TY - JOUR

T1 - Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS

T2 - A Secondary Analysis of the EFRAIM Study

AU - Demoule, Alexandre

AU - Antonelli, Massimo

AU - Schellongowski, Peter

AU - Pickkers, Peter

AU - Soares, Marcio

AU - Meyhoff, Tine

AU - Rello, Jordi

AU - Bauer, Philippe R

AU - van de Louw, Andry

AU - Lemiale, Virgine

AU - Grimaldi, David

AU - Martin-Loeches, Ignacio

AU - Balik, Martin

AU - Mehta, Sangeeta

AU - Kouatchet, Achille

AU - Barratt-Due, Andreas

AU - Valkonen, Miia

AU - Reignier, Jean

AU - Metaxa, Victoria

AU - Moreau, Anne-Sophie

AU - Burghi, Gaston

AU - Mokart, Djamel

AU - Mayaux, Julien

AU - Darmon, Michael

AU - Azoulay, Elie

AU - EFRAIM Investigators

N1 - Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

PY - 2020/11

Y1 - 2020/11

N2 - 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.

AB - 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.

U2 - 10.1016/j.chest.2020.05.602

DO - 10.1016/j.chest.2020.05.602

M3 - Journal article

C2 - 32569634

VL - 158

SP - 1947

EP - 1957

JO - Chest

JF - Chest

SN - 0012-3692

IS - 5

ER -

ID: 61902424