Effectiveness of inspiratory pressure-limited approach to mechanical ventilation in septic patients.

Abstract

Severe sepsis is one of the most common causes of acute lung injury (ALI) and is associated with high mortality. The aim of the study was to see if a protective strategy based approach with a plateau pressure < 30 cm H2O was associated with lower mortality in septic patients with ALI in the Surviving Sepsis Campaign (SSC) international database.A retrospective analysis of an international multicentric database of 15,022 septic patients from the 165 ICUs was used. Septic patients with ALI and mechanical ventilation (n=1,738) had more accompanying organ dysfunction and a higher mortality rate (48.3 vs. 33.0%; p<0.001) than septic patients without ALI (n=13,284). In patients with ALI and mechanical ventilation, the use of a inspiratory plateau pressures maintained < 30 cm H2O was associated with lower mortality by chi-square test (46.4 vs. 55.1%; p<0.001) and by Kaplan-Meier and log-rank test (p<0.001). In the multivariable random-effects Cox regression, plateau pressure < 30 cm H2O was significantly associated with lower mortality (HR=0.84, 95% CI: 0.72-0.99, p=0.038). ALI in sepsis was associated with higher mortality, especially when an inspiratory pressure-limited mechanical ventilation approach was not implemented.