Driving Pressure and Lung Injury in Mechanically Ventilated Patients without Acute Respiratory Distress Syndrome -

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Suttipong Pearpleum
Yutthana Apichatbutr

Abstract

Background: Driving pressure is associated with mortality in patients with acute respiratory distress syndrome (ARDS). However, whether driving pressure is associated with outcomes in mechanically ventilated patients without ARDS is unknown.


Objective: This study primarily aimed to determine the association between driving pressure and severe lung injury (lung injury score ≥ 2.5). The secondary outcomes were to determine the cutoff point of driving pressure associated with severe lung injury and compare patient mortality between severe and non-severe lung injury score in mechanically ventilated patients without ARDS.


Methods: Mechanically ventilated patients without ARDS admitted in the intensive care unit (ICU) of Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, between 2018 and 2020 were enrolled. Baseline characteristics including sex, age, diagnosis, sedative drug, and lung mechanic from the ventilator were recorded. Moreover, the patients’ driving pressure [plateau pressure–positive end expiratory pressure (PEEP)] and lung injury score were obtained. Multivariable logistic regression analysis was performed to determine associations between driving pressure and patient lung severity with lung injury score. The mechanically ventilated patients without ARDS were categorized according to lung injury score ≥ 2.5; then, a severe form of the area under the receiver operating characteristic (AuROC), as a dependent outcome, was observed to determine the association between driving pressure and severe lung injury. The optimal cutoff point of driving pressure that determined severe lung injury was calculated by Youden’s index.


Result: In total, 155 mechanically ventilated patients without ARDS were enrolled. Overall mortality was 28.3%. Driving pressure was associated with severe lung injury (OR, 1.28; 95% CI, 1.15–1.42; p-value <0.001). A good discriminative ability of driving pressure to determine severe lung injury was noted (AuROC = 0.859; 95%CI, 0.768–0.950). The optimal cutoff point of driving pressure indicating severe lung injury was 16 cmH2O with, 89.5% sensitivity (95% CI, 66.9–98.7), 75% specificity (95% CI, 66.9–82.0), 33.3% positive predictive value (95% CI, 20.8–47.9), and 98.1% negative predictive value (95% CI, 93.2–99.8).


Conclusion: In mechanically ventilated patients without ARDS, increased driving pressure was associated with severe lung injury. A driving pressure >16 cmH2O was associated with severe lung injury.

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References

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