Article

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

Spain.
European Respiratory Journal (Impact Factor: 7.13). 04/2012; 41(1). DOI: 10.1183/09031936.00221611
Source: PubMed

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.

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    • "In a recent study, our group found that septic patients without ARDS ventilated with a protective strategy using a plateau pressure < 30 cmH20 had better outcomes and a lower incidence of ARDS than those ventilated without this limit on plateau pressure [28]. Thus, it may be beneficial to implement protective ventilation strategies from the start of mechanical ventilation, not only when ARDS appears. "
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