Résumé
Background: the effect of time and obesity on acute respiratory distress syndrome (ARDS) management and outcome is unclear.Methods: we conducted a retrospective single center analysis of prospectively collected data in a cohort of ARDS patients with obesity (body mass index (BMI)≥30 kg/m2) and without obesity (BMI<30 kg/m2). All included patients were ventilated with a lung-protective mechanical ventilation protocol. The primary endpoint was ventilatory management including ventilatory parameters at day 1 of ARDS onset, prone positioning, and neuromuscular blockers agents (NMBA) use. Secondary end points were 90-day mortality, SOFA score and PaO2/FiO2 ratio at day 1 of ARDS onset.Results: from 2002 to 2022, 914 patients with ARDS were included, 245 (27%) with obesity and 669 (73%) without obesity. The median tidal volume was of 6.44 (5.99-7.07) ml/kg of predicted body weight (PBW) in patients with obesity and 6.18 (5.86-6.91) in patients without obesity (p<0.01, log rank test). In ARDS patients with obesity, set tidal volume decreased significantly over the 20 years period (Mann-Kendall, p=0.02). Use of prone position was higher in patients with obesity (112/245 (46%) vs 227/669 (34%); p<0.001). There was no difference between groups regarding Positive End Expiratory Pressure (PEEP), driving pressure, NMBA use. The 90-day mortality was similar in ARDS patients with obesity (98/245, 40%) and without obesity (303/669, 45%, p=0.10). There was no significant change over time in the 90-day mortality of ARDS patients with obesity (p=0.72) and without obesity (p=0.42). There was no significant difference between groups regarding SOFA score or PaO2/FiO2 ratio.Conclusion: in this 20 years cohort study, ARDS management differed over time and between patients with and without obesity. Further randomized controlled trials are needed to assess if optimizing ARDS management in both patients with and without obesity could result in improved prognosis.