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.
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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 . Thus, it may be beneficial to implement protective ventilation strategies from the start of mechanical ventilation, not only when ARDS appears. "
ABSTRACT: Acute respiratory distress syndrome (ARDS) is common in critically ill patients admitted to intensive care units (ICU). ARDS results in increased use of critical care resources and healthcare costs, yet the overall mortality associated with these conditions remains high. Research focusing on preventing ARDS and identifying patients at risk of developing ARDS is necessary to develop strategies to alter the clinical course and progression of the disease. To date, few strategies have shown clear benefits. One of the most important obstacles to preventive interventions is the difficulty of identifying patients likely to develop ARDS. Identifying patients at risk and implementing prevention strategies in this group are key factors in preventing ARDS. This review will discuss early identification of at-risk patients and the current prevention strategies.04/2013; 3(1):11. DOI:10.1186/2110-5820-3-11
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ABSTRACT: Acute respiratory distress syndrome (ARDS) is characterized by permeability pulmonary edema and refractory hypoxemia. Recently, the new definition of ARDS has been published, and this definition suggested severity-oriented respiratory treatment by introducing three levels of severity according to PaO2/FiO2 and positive end-expiratory pressure. Lung-protective ventilation is still the key of better outcome in ARDS. Through randomized trials, short-term use of neuromuscular blockade at initial stage of mechanical ventilation, prone ventilation in severe ARDS, and extracorporeal membrane oxygenation in ARDS with influenza pneumonia showed beneficial efficacy. However, ARDS mortality still remains high. Therefore, early recognition of ARDS modified risk factors and the avoidance of aggravating factors during the patient's hospital stay can help decrease its development. In addition, efficient antifibrotic strategies in late-stage ARDS should be developed to improve the outcome.01/2014; 2(1):2. DOI:10.1186/2052-0492-2-2
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ABSTRACT: BACKGROUND: Ventilation with low tidal volume is recommended for patients with acute lung injury. Current guidelines suggest limiting plateau pressure (P-plat) to <30 cm H2O for septic patients needing mechanical ventilation. The aim of this study was to determine whether P-plat within the first 24 h of ICU admission is predictive of outcome and whether P-plat < 30 cm H2O is associated with lower mortality rates. METHODS: This study was a retrospective analysis of prospectively acquired clinical data from an ICU of a tertiary referral hospital in central Taiwan. Subjects were included if they were admitted due to sepsis and respiratory failure requiring mechanical ventilation from April 2008 to November 2009. RESULTS: There were 220 subjects (188 males, 32 females) with a median age of 76 y and a mean Acute Physiology and Chronic Health Evaluation II score of 25.0 +/- 6.5. Pneumonia was the major cause of sepsis (85.5%). The hospital mortality rate was 39.1%. P-plat was higher throughout the first 24 h of ICU admission in nonsurvivors. Higher plat was associated with higher mortality rates regardless of acute lung injury. In multivariate regression analysis, P-plat > 25 cm H2O at 24 h after admission was an independent risk factor for mortality (adjusted odds ratio of 2.33, 95% CI 1.10-4.91, P = .03 for hospital mortality). CONCLUSIONS: P-plat within the first 24 h of ICU admission is predictive of outcome, with lower P-plat associated with lower mortality rates. There is no safety margin for P-plat. Limiting P-plat should be considered even at <30 cm H2O in septic patients with acute respiratory failure.Respiratory care 09/2014; 60(1). DOI:10.4187/respcare.03138 · 1.84 Impact Factor