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.

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

CIBERES Universitat Autonòma de Barcelona European Study Group of Infections in Critically Ill Patients Barcelona Spain

Critical Care Center CHU Lille School of Medicine University of Lille Lille France

Department of Anesthesia Intensive Care and Emergency Medicine Fondazione Ospedale Universitario A Gemelli IRCCS; Istituto di Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore Rome Italy

Department of Anesthesiology and Intensive Care 1st Faculty of Medicine and General University Hospital Charles University Prague Czech Republic

Department of Critical Care and Graduate Program in Translational Medicine D'Or Institute for Research and Education Programa de Pós Graduação em Clínica Médica Rio De Janeiro Brazil

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 Multidisciplinary Intensive Care Research Organization St James Hospital Dublin Ireland

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

Department of Medicine and Interdepartmental Division of Critical Care Medicine Sinai Health System University of Toronto Toronto ON Canada

Division of Intensive Care Medicine Department of Anesthesiology Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland

Division of Pulmonary and Critical Care Penn State University College of Medicine Hershey PA

Medical Intensive Care Unit APHP Hôpital Saint Louis Famirea Study Group ECSTRA Team and Clinical Epidemiology UMR 1153 Center of Epidemiology and Biostatistics Sorbonne Paris Cité CRESS INSERM Paris Diderot Sorbonne University Paris France

Medical Intensive Care Unit Hôtel Dieu HME University Hospital of Nantes Nantes France

Pulmonary and Critical Care Medicine Mayo Clinic Rochester MN

Réanimation Polyvalente et Département d'Anesthésie et de Réanimation Institut Paoli Calmettes Marseille France

Terapia Intensiva Hospital Maciel Montevideo Uruguay

Chest. 2020 Nov;158(5):1812-1813. doi: 10.1016/j.chest.2020.06.060. PubMed

References provided by Crossref.org

Acute respiratory distress syndrome in patients with cancer: the YELENNA prospective multinational observational cohort study