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A1132 - Driving Pressure and the Risk of Developing Acute Respiratory Distress Syndrome in Critically Ill At-Risk Patients: Secondary Analysis of a Prospective Multicenter Observational Study
Author Block: M. Jabaudon1, R. Blondonnet1, E. Joubert2, P. Berthelin2, T. Pranal2, L. Roszyk3, T. Godet2, R. Chabanne2, N. Eisenmann4, A. Lautrette5, C. Belville6, V. Sapin3, B. Pereira7, J. M. Constantin1; 1Department of Perioperative Medicine, CNRS UMR 6293, INSERM U1103, GReD, CHU Clermont-Ferrand, Universite Clermont Auvergne, Clermont-Ferrand, France, 2Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France, 3Department of Medical Biochemistry and Molecular Biology, CNRS UMR 6293, INSERM U1103, GReD, CHU Clermont-Ferrand, Universite Clermont Auvergne, Clermont-Ferrand, France, 4Intensive Care Unit, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France, 5Medical Intensive Care Unit, UMR CNRS 6023, CHU Clermont-Ferrand, Universite Clermont Auvergne, Clermont-Ferrand, France, 6CNRS UMR 6293, INSERM U1103, GReD, Universite Clermont Auvergne, Clermont-Ferrand, France, 7Biostatistics and Data Management Unit, Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France.
Rationale: The driving pressure (i.e. tidal volume scaled to respiratory-system compliance, ΔP=VT/CRS) can be estimated at the patient bedside as the difference between inspiratory plateau pressure and positive end-expiratory pressure (PEEP). Recent studies support an association between high ΔP and worst outcome in patients with acute respiratory distress syndrome (ARDS) and between high ΔP and more postoperative pulmonary complications in patients having surgery. However, whether baseline ΔP could predict the risk of ARDS development in patients without ARDS remains underinvestigated.
Objectives: To investigate the predictive value of higher ΔP for the onset of ARDS in a high-risk population.
Methods: Data for this ancillary study were prospectively obtained from intubated adult patients with at least one ARDS risk factor upon intensive care unit (ICU) admission enrolled in a large multicenter observational study on the predictive values of RAGE isoforms and gene variants for the onset of ARDS (PrediRAGE study) between June, 2014 and January, 2015. Patients who had ARDS at baseline or in the subsequent 24 hours were excluded, and the remaining patients were followed for development of ARDS within seven days (primary outcome). Patients who received pressure-support ventilation, or in whom the presence of ventilatory efforts was suspected, were excluded.
Measurements and Main Results: A total of 212 patients were included in this ancillary study, among whom thirty-four developed ARDS at least 24 hours after ICU admission. Patients who developed ARDS within seven days had higher baseline ΔP than those who did not develop ARDS (mean ± standard deviation, 12.5 ± 3.1 versus 9.8 ± 3.4 cmH2O, respectively, P=10-4). The association between ΔP and subsequent development of ARDS within seven days was robust to adjustment for baseline VT, PEEP, illness severity, and sepsis, pneumonia, severe trauma, and shock as primary ARDS risk factors (odds ratio, 1.18; 95% confidence interval, 1.02 to 1.36; P=0.02).
Conclusions: Our results indicate that assessing ΔP may be useful in identifying patients who will develop ARDS within seven days from ICU admission among those with a higher risk for the syndrome.