Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS

Alexandre Demoule; Massimo Antonelli; Peter Schellongowski; Peter Pickkers; Marcio Soares; Tine Meyhoff; Jordi Rello; Philippe R. Bauer; Andry van de Louw; Virgine Lemiale; David Grimaldi; Ignacio Martin-Loeches; Martin Balik; Sangeeta Mehta; Achille Kouatchet; Andreas Barratt-Due; Miia Valkonen; Jean Reignier; Victoria Metaxa; Anne-Sophie Moreau; Gaston Burghi; Djamel Mokart; Julien Mayaux; Michael Darmon; Elie Azoulay; Karin Amrein; Thomas Staundinger; Gottfried Heinz; Gürkan Sengölge; Christian Zauner; Peter Jaksch; Fabio S. Taccone; Anne Pascale Meert; Dominique Benoît; Ulysses V.A. Silva; Ana Paula Pierre de Moraes; Thiago Lishoa; Jorge Salluh; William Viana; Guilliana Moralez; Thiago Domingos Correa; Umesh Shah; Thomas Karvunidis; Balik Martin; Katerina Russinova; Anders Perner; Tine Sylvest Meyhoff; Nielsen Jonas; Ramin Brandt Bukan; Ann M. Moeller; Lene B. Nielsen; Amélie Seguin; Akli Chermak; Nicolas Terzi; Isabelle Vinatier; Florent Wallet; Kada Klouche; Laura Platon; Benjamin Gaborit; François Barbier; Frederic Pène; Antoine Rabbat; Virginie Lemiale; Martine N'Yunga; Christophe Girault; Caroline Lemaitre; Elise Artaud-Macari; F. Bruneel; Anne Sophie Moreau; Anne Kuitunen; Brian Marsh; Mater Misericordia; Aisling Mc Mahon; Gilda Cinnella; Antonella Cotoia; Ospedali Riuniti; Lucas Montini; Angélique Spoelstra de Man; Precious Pearl Landburg; Dennis Bergmans; Pleun Hemelaar; Thomas Kaufmann; Andreas Barrat-Due; Pål Klepstad; Belen Encina; Gabriel Moreno; Llorenç Socias Crespi; Emilio Rodriguez-Ruiz; Andry Van De Louw; Philippe Bauer; Yadav Hemang; EFRAIM Investigators

doi:10.1016/j.chest.2020.05.602

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Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS

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Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS

Alexandre Demoule, Massimo Antonelli, Peter Schellongowski, Peter Pickkers, Marcio Soares, Tine Meyhoff, Jordi Rello, Philippe R. Bauer, Andry van de Louw, Virgine Lemiale, …

Chest, Vol.158(5), pp.1947-1957

11/2020

DOI: https://doi.org/10.1016/j.chest.2020.05.602

PMID: 32569634

Résumé

acute respiratory failure

ARDS

diagnosis

driving pressure

immunocompromised

outcome

plateau pressure

In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement. 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]). 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. 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. 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.

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Titre: Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS
Créateurs - sans rôle: Alexandre Demoule - 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
Massimo Antonelli - EMERGENCY
Peter Schellongowski - Department of Medicine I, Medical University of Vienna, Vienna, Austria
Peter Pickkers - Radboud University Medical Center
Marcio Soares - 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
Tine Meyhoff - Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Jordi Rello - Universitat Autònoma de Barcelona
Philippe R. Bauer - Mayo Clinic
Andry van de Louw - Pennsylvania State University
Virgine Lemiale - 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
David Grimaldi - Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
Ignacio Martin-Loeches - Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO) and Department of Clinical Medicine, Trinity College, Wellcome Trust-HRB Clinical Research Facility, Caring for Critically Ill Immuno-compromised Patients Multinational Network (Nine-I). St James Hospital, Dublin, Ireland
Martin Balik - Charles University
Sangeeta Mehta - University of Toronto
Achille Kouatchet - Department of Medical Intensive Care Medicine, University Hospital of Angers, Angers, France
Andreas Barratt-Due - Oslo University Hospital
Miia Valkonen - Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Jean Reignier - Medical Intensive Care Unit, Hôtel Dieu-HME University Hospital of Nantes, Nantes, France
Victoria Metaxa - King's College Hospital NHS Foundation Trust
Anne-Sophie Moreau - Critical Care Center, CHU Lille, School of Medicine, University of Lille, Lille, France
Gaston Burghi - Hospital Maciel
Djamel Mokart - Institut Paoli-Calmettes
Julien Mayaux - 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
Michael Darmon - Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA
Elie Azoulay - Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA
Karin Amrein
Peter Schellongowski
Thomas Staundinger
Gottfried Heinz
Gürkan Sengölge
Christian Zauner
Peter Jaksch
Fabio S. Taccone
David Grimaldi
Anne Pascale Meert
Dominique Benoît
Ulysses V.A. Silva
Ana Paula Pierre de Moraes
Thiago Lishoa
Marcio Soares
Jorge Salluh
William Viana
Guilliana Moralez
Thiago Domingos Correa
Sangeeta Mehta
Umesh Shah
Thomas Karvunidis
Balik Martin
Katerina Russinova
Anders Perner
Tine Sylvest Meyhoff
Nielsen Jonas
Ramin Brandt Bukan
Ann M. Moeller
Lene B. Nielsen
Achille Kouatchet
Amélie Seguin
Akli Chermak
Nicolas Terzi
Isabelle Vinatier
Anne-Sophie Moreau
Florent Wallet
Djamel Mokart
Kada Klouche
Laura Platon
Benjamin Gaborit
François Barbier
Frederic Pène
Antoine Rabbat
Alexandre Demoule
Julien Mayaux
Elie Azoulay
Virginie Lemiale
Martine N'Yunga
Christophe Girault
Caroline Lemaitre
Elise Artaud-Macari
Michael Darmon
F. Bruneel
Anne Sophie Moreau
Miia Valkonen
Anne Kuitunen
Brian Marsh
Mater Misericordia
Ignacio Martin-Loeches
Aisling Mc Mahon
Gilda Cinnella
Antonella Cotoia
Ospedali Riuniti
Massimo Antonelli
Lucas Montini
Angélique Spoelstra de Man
Precious Pearl Landburg
Dennis Bergmans
Peter Pickkers
Pleun Hemelaar
Thomas Kaufmann
Andreas Barrat-Due
Pål Klepstad
Jordi Rello
Belen Encina
Gabriel Moreno
Llorenç Socias Crespi
Emilio Rodriguez-Ruiz
Victoria Metaxa
Gaston Burghi
Andry Van De Louw
Philippe Bauer
Yadav Hemang
EFRAIM Investigators
Détails de publication: Chest, Vol.158(5), pp.1947-1957
Éditeur: Elsevier Inc
Nombre de pages: 11
Identifiants: 99158752609311
Unité académique: Physiologie et Médecine Expérimentale du coeur et des muscles - PhyMedExp
Langue: English
Type de ressource: Journal article