Association Between Baseline Driving Pressure and Mortality in Very Old Patients with ARDS.

IF 19.3 1区医学 Q1 CRITICAL CARE MEDICINE American journal of respiratory and critical care medicine Pub Date : 2024-10-10 DOI:10.1164/rccm.202401-0049OC

Eleni Papoutsi, Konstantinos Gkirgkiris, Vasiliki Tsolaki, Ioannis Andrianopoulos, Konstantinos Pontikis, Katerina Vaporidi, Spyridon Gkoufas, Magdalini Kyriakopoulou, Anna Kyriakoudi, Elisabeth Paramythiotou, Evangelos Kaimakamis, Clementine Bostantzoglou, Militsa Bitzani, Mary Daganou, Vasilios Koulouras, Eumorfia Kondili, Antonia Koutsoukou, Ioanna Dimopoulou, Anastasia Kotanidou, Ilias I Siempos

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Abstract

Rationale: Due to effects of aging on the respiratory system, it is conceivable that the association between driving pressure and mortality depends on age.

Objective: We endeavored to evaluate whether the association between driving pressure and mortality of patients with acute respiratory distress syndrome (ARDS) varies across the adult lifespan, hypothesizing that it is stronger in older, including very old (≥80 years), patients.

Methods: We performed a secondary analysis of individual patient-level data from seven ARDS Network and PETAL Network randomized controlled trials ("ARDSNet cohort"). We tested our hypothesis in a second, independent, national cohort ("Hellenic cohort"). We performed both binary logistic and Cox regression analyses including the interaction term between age (as a continuous variable) and driving pressure at baseline (i.e., the day of trial enrollment) as the predictor, and 90-day mortality as the dependent variable.

Findings: Based on data from 4567 patients with ARDS included in the ARDSNet cohort, we found that the effect of driving pressure on mortality depended on age (p=0.01 for the interaction between age as a continuous variable and driving pressure). The difference in driving pressure between survivors and non-survivors significantly changed across the adult lifespan (p<0.01). In both cohorts, a driving pressure threshold of 11 cmH₂O was associated with mortality in very old patients.

Interpretation: Data from randomized controlled trials with strict inclusion criteria suggest that the effect of driving pressure on mortality of patients with ARDS may depend on age. These results may advocate for a personalized age-dependent mechanical ventilation approach.

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高龄 ARDS 患者基线血压与死亡率之间的关系

理论依据：由于衰老对呼吸系统的影响，可以想象驱动压力与死亡率之间的关系取决于年龄：我们试图评估急性呼吸窘迫综合征（ARDS）患者的驱动压力与死亡率之间的关系在整个成人生命周期中是否存在差异，并假设这种关系在老年患者（包括高龄患者（≥80 岁））中更强：我们对来自七项 ARDS 网络和 PETAL 网络随机对照试验（"ARDSNet 队列"）的单个患者数据进行了二次分析。我们在第二个独立的全国队列（"希腊队列"）中检验了我们的假设。我们进行了二元逻辑分析和 Cox 回归分析，包括年龄（连续变量）与基线（即试验入组当天）驾驶压力之间的交互项作为预测因子，90 天死亡率作为因变量：根据 ARDSNet 队列中 4567 名 ARDS 患者的数据，我们发现驾驶压力对死亡率的影响取决于年龄（年龄作为连续变量与驾驶压力之间的交互作用 p=0.01）。存活者和非存活者之间的驱动压力差异在成人生命周期中发生了显著变化（p2O 与高龄患者的死亡率相关）：来自严格纳入标准的随机对照试验的数据表明，驾驶压力对 ARDS 患者死亡率的影响可能取决于年龄。这些结果可能主张采用与年龄相关的个性化机械通气方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of respiratory and critical care medicine 医学-呼吸系统

CiteScore

27.30

自引率

4.50%

发文量

1313

审稿时长

3-6 weeks

期刊介绍： The American Journal of Respiratory and Critical Care Medicine focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients. Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish clinical trials and outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Critical Care Perspectives or Pulmonary Perspectives. These are generally focused on a more limited area and advance a concerted opinion about care for a specific process. Concise Clinical Reviews provide an evidence-based synthesis of the literature pertaining to topics of fundamental importance to the practice of pulmonary, critical care, and sleep medicine. Images providing advances or unusual contributions to the field are published as Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences. A recent trend and future direction of the Journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.