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Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study
A. Demoule, M. Antonelli, P. Schellongowski, P. Pickkers, M. Soares, T. Meyhoff, J. Rello, PR. Bauer, A. van de Louw, V. Lemiale, D. Grimaldi, I. Martin-Loeches, M. Balik, S. Mehta, A. Kouatchet, A. Barratt-Due, M. Valkonen, J. Reignier, V....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, multicentrická studie, pozorovací studie
- MeSH
- dechový objem fyziologie MeSH
- imunokompromitovaný pacient * MeSH
- lidé středního věku MeSH
- lidé MeSH
- mechanika dýchání fyziologie MeSH
- následné studie MeSH
- prognóza MeSH
- prospektivní studie MeSH
- senioři MeSH
- syndrom dechové tísně imunologie patofyziologie terapie MeSH
- ventilace umělá s výdechovým přetlakem metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
BACKGROUND: In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement. RESEARCH QUESTION: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [ΔPrs]). STUDY DESIGN AND METHODS: This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, ΔPrs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality. RESULTS: Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.01-2.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher ΔPrs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: ΔPrs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality. INTERPRETATION: In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.
Critical Care Center CHU Lille School of Medicine University of Lille Lille France
Department of Critical Care King's College Hospital NHS Foundation Trust London England
Department of Emergencies and Critical Care Oslo University Hospital Oslo Norway
Department of Intensive Care Hôpital Erasme Université Libre de Bruxelles Brussels Belgium
Department of Intensive Care Medicine Radboud University Medical Center Nijmegen The Netherlands
Department of Intensive Care Rigshospitalet University of Copenhagen Copenhagen Denmark
Department of Medical Intensive Care Medicine University Hospital of Angers Angers France
Department of Medicine 1 Medical University of Vienna Vienna Austria
Division of Pulmonary and Critical Care Penn State University College of Medicine Hershey PA
Istituto di Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore Rome Italy
Medical Intensive Care Unit Hôtel Dieu HME University Hospital of Nantes Nantes France
Pulmonary and Critical Care Medicine Mayo Clinic Rochester MN
Citace poskytuje Crossref.org
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- $a Demoule, Alexandre $u AP-HP Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France. Electronic address: alexandre.demoule@aphp.fr
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- $a Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study / $c A. Demoule, M. Antonelli, P. Schellongowski, P. Pickkers, M. Soares, T. Meyhoff, J. Rello, PR. Bauer, A. van de Louw, V. Lemiale, D. Grimaldi, I. Martin-Loeches, M. Balik, S. Mehta, A. Kouatchet, A. Barratt-Due, M. Valkonen, J. Reignier, V. Metaxa, AS. Moreau, G. Burghi, D. Mokart, J. Mayaux, M. Darmon, E. Azoulay, EFRAIM Investigators
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