RELATIONSHIP BETWEEN RESPIRATORY SYSTEM MECHANICS, OXYGENATION AND MORTALITY IN THE FIRST 7 DAYS OF MECHANICAL VENTILATION.
Keywords:
mechanical ventilation, driving pressure, PaO2/FiO2 ratioAbstract
Objective
To analyze the association between respiratory system mechanics (RSM), oxygenation, and mortality in the first 7 days of mechanical ventilation in patients admitted to the intensive care unit of a public hospital.
Materials and Methods
A cross-sectional analytical study with retrospective case series data was conducted between January 2023 and June 2023.
The following variables were recorded: age, gender, APACHE II, SAPS II, medical history, reason for ICU admission, days of mechanical ventilation (MV), mode and tidal volume (VT) on days 1, 3, and 7 of MV, predicted body weight (PBW), ICU length of stay, and RSM expressed by DP, oxygenation measured by Pa/FiO2, and mortality in the first 7 days of mechanical ventilation (MV).
Results
A total of 70 patients were included. The mean age was 51.9 years, with men being the predominant gender in this sample at 61.4%. Neurological reasons for admission predominated at 38.6%. The median days of MV were 4 days. The ICU length of stay was 7.5 [4 – 14.75] days with a total mortality in this sample of 42.9%.
Conclusion
In this case series, DP and Pa/FiO2 on day 1 of MV were significantly associated with ICU mortality in this group of patients. There was no statistical significance for the other days of MV.
References
Slutsky AS. History of Mechanical Ventilation. From Vesalius to Ventilator-induced Lung Injury. Am J Respir Crit Care Med [Internet]. 2015 May 15;191(10):1106–15. Available from: http://dx.doi.org/10.1164/rccm.201503-0421PP
Goligher EC, Ferguson ND, Brochard LJ. Clinical challenges in mechanical ventilation. Lancet [Internet]. 2016 Apr 30;387(10030):1856–66. Available from: http://dx.doi.org/10.1016/S0140-6736(16)30176-3
Sutherasan Y, Vargas M, Pelosi P. Protective mechanical ventilation in the non-injured lung: review and meta-analysis. Crit Care [Internet]. 2014 Mar 18;18(2):211. Available from: http://dx.doi.org/10.1186/cc13778
Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med [Internet]. 2000 May 4;342(18):1301–8. Available from: http://dx.doi.org/10.1056/NEJM200005043421801
Amato MBP, Meade MO, Slutsky AS, Brochard L, Costa ELV, Schoenfeld DA, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med [Internet]. 2015 Feb 19;372(8):747–55. Available from: http://dx.doi.org/10.1056/NEJMsa1410639
Ball L, Costantino F, Orefice G, Chandrapatham K, Pelosi P. Intraoperative mechanical ventilation: state of the art. Minerva Anestesiol [Internet]. 2017 Oct;83(10):1075–88. Available from: http://dx.doi.org/10.23736/S0375-9393.17.11970-X
Guérin C, Papazian L, Reignier J, Ayzac L, Loundou A, Forel JM, et al. Effect of driving pressure on mortality in ARDS patients during lung protective mechanical ventilation in two randomized controlled trials. Crit Care [Internet]. 2016 Nov 29;20(1):384. Available from: http://dx.doi.org/10.1186/s13054-016-1556-2
Esteve F, Lopez-Delgado JC, Javierre C, Skaltsa K, Carrio ML, Rodríguez-Castro D, et al. Evaluation of the PaO2/FiO2 ratio after cardiac surgery as a predictor of outcome during hospital stay. BMC Anesthesiol [Internet]. 2014 Sep 26;14:83. Available from: http://dx.doi.org/10.1186/1471-2253-14-83
Plotnikow GA, Gogniat E, Accoce M, Navarro E, Dorado JH, EpVAr study group. Epidemiology of mechanical ventilation in Argentina. The EpVAr multicenter observational study. Med Intensiva [Internet]. 2022 Jul;46(7):372–82. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2173572722000923
Esteban A, Frutos-Vivar F, Muriel A, Ferguson ND, Peñuelas O, Abraira V, et al. Evolution of Mortality over Time in Patients Receiving Mechanical Ventilation. Am J Respir Crit Care Med [Internet]. 2013 Jul 15 [cited 2023 Oct 10]; Available from: http://dx.doi.org/10.1164/rccm.201212-2169OC
Azevedo LCP, Park M, Salluh JIF, Rea-Neto A, Souza-Dantas VC, Varaschin P, et al. Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study. Crit Care [Internet]. 2013 Apr 4;17(2):R63. Available from: http://dx.doi.org/10.1186/cc12594
Tomicic V, Espinoza M, Andresen M, Molina J, Calvo M, Ugarte H, et al. [Characteristics and factors associated with mortality in patients receiving mechanical ventilation: first Chilean multicenter study]. Rev Med Chil [Internet]. 2008 Aug;136(8):959–67. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18949178
Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA [Internet]. 2002 Jan 16;287(3):345–55. Available from: http://dx.doi.org/10.1001/jama.287.3.345
Navarrete-Navarro P, Ruiz-Bailén M, Rivera-Fernández R, Guerrero-López F, Pola-Gallego-de-Guzmán MD, Vázquez-Mata G. Acute respiratory distress syndrome in trauma patients: ICU mortality and prediction factors. Intensive Care Med [Internet]. 2000 Nov;26(11):1624–9. Available from: http://dx.doi.org/10.1007/s001340000683
Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA [Internet]. 2016 Feb 23;315(8):788–800. Available from: http://dx.doi.org/10.1001/jama.2016.0291
Aoyama H, Pettenuzzo T, Aoyama K, Pinto R, Englesakis M, Fan E. Association of Driving Pressure With Mortality Among Ventilated Patients With Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis. Crit Care Med [Internet]. 2018 Feb;46(2):300–6. Available from: http://dx.doi.org/10.1097/CCM.0000000000002838
Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L, et al. Evolution of Mechanical Ventilation in Response to Clinical Research. Am J Respir Crit Care Med [Internet]. 2012 Dec 20 [cited 2023 Oct 10]; Available from: http://dx.doi.org/10.1164/rccm.200706-893OC
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